The First Day

‘The week to stay out of hospital.’ ‘Death week.’ ‘Don’t get sick today!’

The newspapers just love to turn this day into a circus, they do it every year. It might be because, as we reach the first Wednesday in August, there isn’t normally much else going on to report about and so the slightest chance for those reporters to whip up panic can’t be passed by. I mean, there are only so many times you want to report on the lack of summer sun reaching record levels if you don’t want to be held responsible for a mass suicide. It was those kind of headlines I saw as I made my way past the shop by the front entrance to the hospital on that first Wednesday in August. That was the day that hospitals up and down the country were to be hit by something much more dangerous than any government reform, more lethal than any super bug. What could it be? I hear you scream as you clutch your chest, panic stricken. This is the day every year that the leash is finally taken off and hundreds of newly qualified doctors are unleashed onto the wards for the first time. Five years at medical school did nothing to prepare us for that first day.

Luck was never on my side. That first day also just happened to be the first time I was ‘on call’. This meant that there would be no nice cushy induction for me with my new team, no coffee and a welcome chat with my new consultant, no I was plunged into the chaos that is a Medical Admissions Unit in a busy inner city hospital. This was not enough of a trauma however, as well as being lost in an alien environment of this busy department, I would also be stuck here for at least the next twelve hours. No leaving at 5pm for me, I was going to see the day through, one way or the other! Maybe the papers were right, this is the day to stay out of hospital.

As I took the bleep off the exhausted looking night doctor, I realised he was me one year from now. The handing over of the on call bleep marked the end of his first year working and from the look in his eyes, it could not have come quicker. The clothes were crumpled, the hair was dishevelled and the bags under his eyes looked like you could take a nap in them. He put his hand on my shoulder, like a fallen captain passing on the baton to his lieutenant, he wished me luck without quite finding the energy to smile and turned around and left before I could even say thanks. It was at that moment that I realised how unprepared I really was for this.

Medical School had been hard work. Don’t get me wrong, there had been a lot of fun but the parts that stick in my mind, when I wake in a cold sweat at 4am, consist of hard work. Getting up at 4.30am to travel over two hours on various buses to get to the hospital I had been sent to on time for the Midwife handover just to be told they were too busy for me to join them that day. Standing in theatre as an eye was being removed trying desperately to look interested while at the same time fighting off waves of nausea and the sudden urge my body had to collapse right there on the floor in front of everyone. The exams; spot tests where you had to point out anatomical markings on a cadaver, slide shows were vague images were flashed over computer screens for you to comment on and diagnoses, or worst of all, the clinical exams, where you had to show off as much of your knowledge as possible in front of an examiner with an actor as a patient, all of these done while the clock was ticking.

I had survived all of that, could tell you the meaning of ADME, which blood vessel supplies the Latissimus Dorsi and the name of the cells to be found in the kidney, yet I still felt I hadn’t a clue how to be a real doctor. Three weeks before the newbies start work we get to ‘shadow’ the person doing the job we will be starting with. All these three weeks did however was to work me up into even more of a panic. I was ready to learn the best way of getting blood from an obese patient and how to react to a medical emergency on my ward, what I wasn’t ready for was the politics of being a house officer. If I wanted a CT scan I had to prey for a certain radiographer to be on duty as she might say yes, if she wasn’t there I had to go down and offer to sell my left testicle to get the scan done and I had to do it before the hordes of other house officers from every ward in the hospital arrived to do the same. If my consultant asked for a CTPA, Chest X Ray or even MRI, it was not my job to ask why it was needed, no matter how unclear his reasoning was, it was however my job to know why when filling in the request card as – ‘consultant said so’ apparently isn’t a valid reason. Then there was phlebotomy, the blood takers, they would do a round every day but would get there at 7am, two hours before I started work, so I had to remember to get the blood cards in before I left the night before otherwise three hours of my day would be spent bleeding the twenty patients I had on the ward. These were simple compared to the incredibly complex etiquette involved in communication with the nurses and ward clerk. Some examples of this;

1. Nurses are boss and junior doctors were to remember that. The consultant liked to think he was boss, he was wrong.
2. Never get cocky or rude with a nurse, they can easily ruin your life if spoken to in the wrong tone.
3. Never sit in the ward clerk’s chair, that is her chair, it is not and never will be your chair.
4. Don’t ask a nurse to make you a coffee but always offer to make them a coffee and comment on how busy they look.
5. Always remember please and thank you, never shout and never, ever play the doctor card with them.

 

Yes, I had spent time on wards before, I had spoken to patients, taken blood and put in cannula but before as soon as the going got tough, all I had to say was – ‘I’ll just get the doctor for you.’ I couldn’t do that anymore though, now I was the doctor. What if I make a mistake? What if I can’t get blood out of the patient? What if I can’t think of the dose to prescribe? What if someone dies? The thoughts started racing through my head at such a rate I thought I was going to have a full on panic attack. The adrenaline started to surge and my body got ready to respond – fight or flight? The age old question, but right now it wasn’t a Woolly Mammoth attack I was braced for, it was much worse, this was a post take ward round with a team of people who had no idea how incompetent I really felt. Into the valley of death…