Tales from the wards - Sink or Swim

FY2 Dr Rachel Eyre recalls her first morning as a doctor, where she was the only doctor monitoring a ward of 30 trauma and orthopaedic patients.

A year has passed but the memory of my first day as a doctor is still just as vivid as the day it happened. Nothing drastically terrible occurred; it was just an intense crash course in how to be a physician.

I was warned in advance that the ward would be short staffed for the day; I would be the only doctor for 30 trauma and orthopaedic patients until the afternoon, when the new FY2s and CT would arrive to provide reinforcements.

A whole morning, six hours, on my own, pretending to know what I’m doing. I had one aim; keep everyone alive until my new team arrive.

The first challenge of the day was a fast paced trauma ward round for which I was the scribe. I had SOAP in my head, but then all kinds of phrases and acronyms were thrown at me which I didn’t understand. Fortunately the registrar and nurse took pity and whispered word for word, letter for letter what to write: “TTWB, touch toe weight bear.” Of course!  

“You’ll get used to it,” they said. It just didn’t feel possible at the time.

With the ward round done I found some cake and started eating, only to be quickly interrupted.

"Doctor, the gentleman in the side room has a Hb of 68.” 

At the time this was a huge deal in my head: “Quick, we need to transfuse before they lose every last drop of blood.”

The nurses were on hand to guide me through every phone call and form required to order blood. Then I found out he had ESBL in his urine and we needed to change his antibiotics. Ten minutes later, brain dead and feeling totally out my depth, I put down the phone after having my first bizarre and convoluted conversational experience with the resident eccentric microbiologist.

By this point it was 10am, only a few more hours until help would arrive. Everyone was still alive, I was doing well.

Next challenge, a female post-operative patient needed to go to the “local not so local” tertiary centre for dialysis as her usual centre would not accept ambulatory patients. This meant discussing her with the renal consultant to get her accepted for transfer.

I was prepared for the worst; to be picked apart, chewed up and spat out based on my OSCE experience.

I fanned out all the relevant documents at the workstation, with SBAR written in front of me.

“I can do this,” I told myself. “I’m a strong independent doctor.”

First question, observations - I didn’t have the obs chart.

Second question, bloods – I didn’t have them up on the screen.

SBAR went out of the window, I was lost.  Fortunately the consultant was patient and managed to tease out all relevant information so he could accept her. Apparently senior doctors can be really nice, who knew?

By midday I was working through a barrage of jobs from nurses, but people were still alive and kicking. I was so close, I could almost smell help arriving.

The rest of my new team turned up at 1pm and I tried to handover all of the very much alive patients I had tended to on my own.

But instead of the expected congratulations I was greeted with a grilling on everything I had and hadn’t done, and not even a hello. They wanted to know the daily operations and updates, and challenged most of what I said.

I just wanted to stop and shout: “I’ve been a doctor for a grand total of five hours, I DON’T KNOW!”

Instead I explained what I knew.  Later one of the FY2s realised it was my first day and congratulated me for holding the fort.

My first day taught me a lot. Remember you have prepared a long time at medical school for this and it is totally manageable. Getting through the morning on my own, although a small feat, filled me with a confidence that the next four months would be okay. Tasks which were once like climbing Kilimanjaro are actually now simple, yet significant, day to day occurrences.

On top of everything, what I took away from this day was the reception of my new team; it was as if they had suffered first day amnesia. I swore I would never forget my first day, never forget to say hello and never forget to thank people.