Every year, in August, something extraordinary happens in the NHS. Thousands of young people, mostly in their mid-twenties, give up a label for which society has very low esteem – student – and adopt another, for which it has sky-high expectations: doctor.
The media – including this newspaper – call it "Black Wednesday". And the following few weeks, in which new doctors learn the ropes and mortality rates have been observed to go up all round the country, have been unforgivingly branded "the killing season".
But behind the headlines are more than 6,000 people shouldering a new and heavy burden, knowing that people's lives and the future of the NHS have been placed in their hands.
Dr Elly Pilavachi, 27, is one them. She is a newly qualified doctor, whose first placement is on a haematology ward at the Royal Free Hospital in north London, caring for patients with blood cancers and other serious conditions. Here she shares her experiences and reflections on her first week.
Dr Elly Pilavachi's first day
Wednesday 7 August
I was very, very nervous this morning and it turned out to be a long, busy day. My feet are killing me and I didn't really get to eat or drink properly, but the team were really nice.
I resent hearing about "Black Wednesday" or "the killing season" – it gives everything a very negative air, in what is already an incredibly scary experience for any new doctor. Junior doctors shadow their senior colleagues before they actually start – the Royal Free has a really good programme and I did seven days. It's made so much difference.
We had a patient who received some bad news today. Her whole care team came down to speak to her about it. It was good to see the doctors take the time out of a very busy schedule to really give that patient the time of day. She wasn't rushed, even though we all had a million and one things to do. That was a good lesson.
Thursday 8 August
I thought with the first day out of the way it might be a bit less busy – it wasn't.
Embarrassingly, I failed when I tried to take blood from a patient – it's one of the basic tasks that I really should be able to do. I had to ask my senior to do it instead. I found the vein, thought I was in, but obviously I wasn't because no blood was coming out. So, I repositioned and tried again – to no avail. I'd stuck the needle in the patient twice for no reason.
I don't know what went wrong; I've done it before. The patient was fine with it, thankfully, but I really felt I'd let the team down.
I've been texting my friends who are starting at wards around the country. Some have already burst into tears, some have been yelled at. I've been relatively lucky.
Friday 9 August
Today I managed to take lots of blood and have regained my confidence! I also managed to pre-empt what my seniors asked me to do and arranged some investigations for patients before they even had to ask. Small victories.
I also spent a lot more time with the patients. A patient's family actually thanked me for what I was doing, which was really nice.
It's still daunting, thinking that this is going to be the rest of my life. I'm still scared about my first night shift and my first on-call, which will come next year. I hope I'll have developed the skills to manage that. I think the most dangerous doctor is one who is too arrogant to ask for help – and that's something I don't have a problem with. People don't initially trust you until you prove yourself, which is fair enough. Now I have the weekend off – which I'm really looking forward to.
Saturday 10 August
I went a bit crazy and cleaned the entire flat – what a rock'n'roll lifestyle we young doctors have. I haven't fully moved in, so it was good to get settled. On Saturday evening I went to the Classic Urban prom at the Royal Albert Hall – only £5 for standing tickets! Feel quite apprehensive about going back to work.
Monday 12 August
Today was just horrible. I didn't sleep very well last night. I got to work early at 7am to check that all the blood tests and other things I'd ordered before leaving on Friday had been done. We had our consultant ward round and it turned out I hadn't done everything he wanted me to do last week, because I'd misunderstood. I got told off and felt like an idiot. It's just inexperience, I know, but like a lot of medics I have this urge to do the best I can. I felt that I was really disappointing people.
There was also a new patient, close to me in age, who is really sick and feeling quite alone and overwhelmed. It was so sad. We had various other patients who aren't doing well. I think it all got to me. When I got home I had a snack and really pathetically just crawled into bed and tried to forget about anything. I think I take things more personally than I should do. I'm sure I'll develop a thicker skin.
Tuesday 13 August
Today was much better. Everything seemed to go OK and I even finished on time. My registrar has a wonderful manner. She treats everything we do as a team effort. She'll ask me a question and I will say: "Oh, I'm an idiot for not knowing that," and she will say: "No, it's my responsibility for not having taught you." Before I left medical school we had lectures about preparation for practice.
We were told to think about who we were going to be when we became doctors – rather than medical students with no responsibilities. It's something I've thought a lot about. I've considered superficial things like the way I dress, the way I do my hair, the way I do my make-up: all to give off this air of professionalism – to be Dr Pilavachi rather than Elly the medical student.
But you can also be cheerful – you don't need to change who you are. The reason I went into medicine rather than the law or business is that I like interacting with people. So I really want to maintain that personable side.
Wednesday 14 August
Busy, and finished late (again) but a good day. I spent a lot of time with patients and even got to use my stethoscope twice – record!
One gentleman showed me an article in a newspaper about how the NHS was apparently coming to an end. He talked about how sad that would be and how good his treatment had been here. On this ward there are very sick patients who are getting really expensive treatment, but money just isn't a consideration when it comes to planning how to look after them. They don't have to worry about it. That's what's amazing about the NHS.
I've already had to stop myself from crying a few times. I want to go into oncology. I'm aware the patients I will work with throughout my career will be very sick and many won't survive.
Thursday 15 August
Still working through lunch and leaving late. We had our consultant ward round again. But this time I knew the patients better, predicted the issues that would come up and was able to help the consultant and he seemed happy. I hope he thinks I'm more reliable now.
Friday 16 August
Tough day today. We have some patients going through very hard times. Then a few small things went wrong and I just burst into tears – for no single reason. I think I just felt overwhelmed at all the things I had to do, and how afraid I was of messing things up.
I just need to know to ask for help when I need it. All the doctors I've worked with have been so inspirational. They do everything they can for the best of their patients. The patients, as well, are inspiring. They are going through such tough treatments, away from home, and are so brave, so uncomplaining and cheerful.
On the whole I think I am getting better day after day. Progressing forward through my career will be hard and a long haul – but I'm looking forward to everything that's to come.