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Non-Residents On Call #2 – Midnight Perils

I just called to say… we need you

Non-Residents On Call are doctors covering part of a shift off-site, being available over the phone for advice or available to come in for emergencies.What is commonly refer to as being on call – taking referrals and dealing with emergencies during the day or at night, while based on site, is, in terms of NHS contracts, is being “on-take”.

This is the second in a three-part series. Read Part #1 here, and Part #3 here.


Midnight Train to Crazy

If you are able to stay at home to cover your NROC, make sure you have an idea of how you’re going to get in at night. Getting the night bus into work late on a Friday or Saturday night can be the most miserable experience. Everyone else is out enjoying themselves, letting their hair down, drinking, drunk, or eating a kebab, or someone else’s face.  Or getting stabbed, or assaulted and ending up in hospital so I should get some perspective and appreciate that the purpose of my hospital visit is preferable to some others.

SHO(t) in the Dark

After a long week I had managed to get home and into bed, with my on call phone next to me on loud. I was exhausted. I had drifted off into one of those deep sleeps where your body feels so heavy it’s hard to overcome the sleep inertia to wake up or lift limbs. I had a strange dream about car alarms, which must have been my dreamy interpretation of my ringtone, and I found myself holding my phone to my ear and someone speaking at me. It took me a few minutes to come around and understand what was going on. I was being called by the SHO about a patient who hadn’t passed urine all day and was in urinary retention. The SHO couldn’t get a catheter in.

The first thing I needed to establish was did this patient really need a catheter? Was he in retention and was he in pain? The answer to all these questions was yes. It sounded like I needed to head in. I didn’t have my car with me and it was cold and raining so I decided to head to the end of the road and catch the night bus in.

It was about 1am on Friday night and the bus was full of people heading from the pub, home, or to carry on their revelry. I was feeling pretty sorry for myself so busied myself catching up with the sports news on my phone.

Get Better?

I got into work, headed to the ward, picking up some catheters and kit on the way. I found the patient, a frail, bed-bound man with advanced dementia, fast asleep in bed. I looked through his notes and gently woke him to examine him. As I drew his blankets down and unfastened the continence pad he was wearing he emptied his bladder with a strong flow, saturating the pad. A quick bladder scan showed he had successfully emptied his bladder and didn’t need catheterisation at all. Less than 5 minutes after arriving I was heading back out to get the night bus back home.

The bus arrived, I was tired and just wanted to be back in bed. The bus was packed with worse for wear people, winding down on the way home, a few people tucking into fast food boxes, a few staggering to stay upright holding onto the rails and a man sitting in the seat behind the driver, apparently asleep. I saw a free seat opposite the slumped man and swung myself up towards the seat.  Out of nowhere a hand grabbed my shoulder and pulled me sharply back, out of the seat before I could plant myself down. A further strong tug pulled me upright,  into the aisle. I panicked thinking I was going to be mugged or stabbed. “Don’t sit there!”. The grip softened and let go. I =looed at the no longer sleeping man, he looked calm and friendly and in no way a threat. “There’s vomit on that seat, mate”. I looked down and saw a puddle of fresh chunder all over the seat I was about to slash down in. If it wasn’t for the man I now remember as my “night bus angel” I would have capped off my pointless trip in with vomit stained trousers.

Since that night I cycled in even when it was pouring with rain and the wind was howling. One weekend I clocked up 100km on a single-speed bike one call out at a time! Make sure you have good working lights and a decent helmet.

Bet It Feels like You’re Living There!

A female colleague of mine lived too far from a London hospital to go home overnight so she stayed in the on call room. The rooms were bright, ensuite, newly refurbished, but as they were a couple of hundred meters down the road from the hospital, whenever she had to go in at night, she would call the hospital security to ask them to meet her at the accommodation and walk her in. I would recommend this even if you are going home late at night and your car is at the far end of the car park.

Lucky Thing, This Car

A note on driving into work at night: check your car insurance policy and whether you have business mileage included. If anything happens to you while driving in for an emergency you will only be covered by business mileage. Bear in mind, you’re likely to be tired and no matter how good a driver you are and how quite the roads are there is still risk. I was almost wiped out on a roundabout one night.

Also, you need to have business mileage cover to be able to claim back for journeys in for emergencies and between your base hospital and any other sites.

Make sure you do claim for any journeys in for emergencies. You will need a claim form and usually a departmental code to be able to get the money back. Don’t be fobbed off but people saying its impossible, just keep asking around until you find the right person to speak too. It can add up to hundreds of pounds per year.


Read Part #1 here, and Part #3 here.

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