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Black Wednesday: First Day

From our Lead Surgical Contributor, Dr. Paul Sturch.

Its called Black Wednesday. The first Wednesday in August. The first day for all new doctors. I used to think that the hospitals would prepare for this and make sure there was a lot of support and senior cover available, but that’s just not true. How naive of me. It’s the middle of the kids’ summer holidays and other people have lives too. Still – at the time, it was quite a shock.

Over Here, Coach!

From what I’ve seen, medical students are now getting much more coaching prior to hitting the wards. When I was preparing to begin my F1 year, I had a fortnight of shadowing a current F1 doctor in the July, but still didn’t have a clue what was going on when I started. There’s a massive difference between being book smart, full of basic sciences knowledge, having the ability to name all the conditions associated with rare syndromes, and describing musical heart murmurs – and real life on the wards. Far more important is knowing which folder the patient list is stored in, where to find an X-ray form, and how to order an echo.

On my first day as a ‘proper doctor’ on the medical wards as a cardiology F1, my team was post-take. All new medical patients admitted to hospital in the last 24 hours were admitted under the team’s supervision, and as an extension, my care. I had the cardiology patients on my regular ward and all the new general medical patients in the acute medical unit to see – amounting to about 50 patients in total.

Brown Trousers Time

I arrived on the ward and collected a patient list, I checked it twice and full of first day anxiety, went to find the rest of the team. That’s when I found out that my SHO was in the trust induction and wouldn’t be around until the next day, the Consutlant and registrar were doing a clinic at another site for the morning and wouldn’t be back until the afternoon, and it was just me on my own. Not knowing any better and not wanting to let the side down, I pulled my socks up, put on my ‘brown trousers’ and started seeing patients.

Unsurprisingly, it took me an age to see each patient, and my management plans did not stray from what the SHO or Med Reg had written when clerking the patient in. I diligently wrote down the obs, hugely relieved when patients hadn’t dropped their blood pressure or become septic overnight and continued their fluids, antibiotics, and analgesia.

Not long into the round, maybe two or three patients and an hour in – I later found that this was fairly quick for the average medical ward round – I was bleeped by a nurse on a ward I had never heard of about a patient I had never heard of asking me to prescribe emergency sedation as the poor man was agitated and hitting staff. I could remember the exact seat I was in during the lecture on sedation, the person I was sitting next and wonderful early summer balmy weather outside, but could not, for the life of me think of what I should do in this situation. I asked the nurse what they usually give (a trick that has served me incredibly well over the years when I haven’t known what I was doing) and she suggested “Anything, prescribe a shovel so we can knock him out.” As I wasn’t sure whether a shovel would be prescribed on the regular or PRN side of the drug chart or whether I should prescribe a generic or brand shovel I found a med reg I recognized and asked for help.

The poor guy was busy himself but took pity on me and came with me to see the patient. He sat the patient down in a quiet room and talked with him for a few minutes. The patient had dementia and had become anxious and agitated away from his home environment. The over-stretched, under-staffed ward made didn’t help his situation. After a few minutes he was calmer and the situation defused.

Do the Robot

Important lesson learned and now – back to the ward round. Around lunchtime (I’m guessing because I don’t think I ate lunch during my first week) I received a call from the blood bank about a ward patient with worryingly low haemoglobin. They helpfully suggested that one way to mange this would be a blood transfusion. I knew all about ABO and Rhesus groups, transfusion reactions and haemoglobin molecules, but didn’t have a clue how to go about transfusing someone. No med reg in sight to ask. I felt completely useless, helpless and out of depth. I’d spent six years studying at university and here I was failing at everything put before me on my first day. I was feeling pretty hopeless, but, thankfully, my consultant arrived back on site and was able to take care of the situation. She gave me a list of simple jobs to do and sorted out the sick patients herself, I just kept moving robotically until all the jobs were done.

I can’t remember much else of what happened that day apart from leaving, feeling completely shattered covered in that rancid, sticky sweat of anxiety, and immediately regretting my career choice. When I turned up to the ward the next day I asked my consultant for some feedback. She replied: “After a day like yesterday, you turned up again today. That means you’re doing great.”

Another New Job

When we change over jobs we finish one job on the Tuesday and start in a new trust, which might be in another region, the following day. Some people will inevitably be on nights, finishing their night shift at the exact time their next job starts, or they might be thrown straight into a night shift at their new job. Its not ideal, its not very well planned, its just the way it works.

The first day on any new job is always going to be difficult, its likely going to be stressful, tiring and fill you with anxiety. The important thing to remember is that we have all been there before, the nurses have seen it all before and whatever stage you are at in your career, there is always someone to ask for help. Accept that it’s going to be tough, prepare as best you can, stay calm, and make sure you help the poor bastard looking terrified on their first day.


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