A couple of years ago, when I first embarked on this crazy life, I started writing a book* (sorry for those of you that know this already). Here’s what happened on my first day as a doctor EVER…
Tragically for the patients, I’d drawn the rota short straw and ended up spending my first day on call. This means that I have to spend the day in A&E clerking in patients – trying to get to the bottom of why they collapsed in the supermarket, or have lost the use of one arm, or can only see the colour purple, while being intermittently violently torn away as my bleep screams ‘Cardiac arrest on MAU on floor one…’ Whereupon I’m expected to down tools, run to the scene of the arrest, and attempt to bring someone back to life.
Contrary to the impression that Holby City gives, it is almost impossible to revive someone by CPR alone, and the success rate of a defibrillator is also pretty rubbish. So mostly a crash call involves watching a doctor heave up and down on some poor dead patient’s chest, while another doctor shocks them every two minutes, in an increasingly desultory way, until all parties agree the patient isn’t going to come back miraculously from the dead, and in fact had already crossed the river Styx some 20 minutes back.
Back in A&E, I was handed a needle and some blood bottles, and sent to a side room, with the fateful words ‘She’s really young – 30’s. She’ll have veins like pipes, you won’t even have to aim the needle. Just chuck it in her direction and you can’t fail to hit blood.’ The reality was a needle phobic, who seemingly had no veins at all. After causing her to cry for an hour, while sticking various parts of her body with needles, she begged me to stop. Whereupon I got a nurse. Who, fortunately for my ego, had the same amount of trouble, before finally locating a vein in the poor woman’s leg.
All of which paled into insignificance against my next patient – an old man with multiple comorbidites who had been vomiting continuously for three weeks, and who’s GP was worried, ‘had a blocked ‘ventriculoperitoneal shunt’. I had no idea what a ventriculoperitoneal shunt was, until I looked on google and discovered that it was a tube linking the patient’s brain to his abdominal cavity, which relieved the pressure on his brain. Prior to the shunt being inserted, his brain produced too much cerebrospinal fluid (the stuff that coats your brain and spinal cord), which led to a build up of pressure inside the poor man’s skull, meaning his delicate soft brain was getting squished. And now the shunt was ‘?blocked’, so his GP was worried that this is happening again. And all I’m thinking as I carefully question him about the exact nature of the vomit is, ‘It is my first day as a doctor. What in the name of god am I supposed to do about it?’
The answer, as ever in medicine, is ‘tell a senior’. In my case, this was a cocky young cardiology registrar, who told me exactly how worthless I was, and then referred the patient onto the neurologists, who might have been able to help.
On my midnight cycle home in the dark (bike lights naturally nicked off my bike in the hospital car park). I reflected on what I had learnt. And what I had learnt mainly was where the loos were. And how to stab a cowering woman repeatedly without flinching. I was becoming a doctor.
*In order to maintain patient confidentiality it’s necessary to point out that I have altered patient’s details and amalgamated the stories of patients I, or my colleagues, have met over the years. So although these stories represent accurately what would happen in a hospital, they are not direct representations of true patients.