A crazy week…or how I love my registrar

Wow, it’s over, my first week on call. It was not a good one, all in all. For those of you who are unfamiliar with the on-call system, in my hospital I work from 9am to 9:30pm. Until 5 is just a normal day, then from 5-9 everyone else goes home and it’s just me. Which in itself is pretty scary.

It basically started badly on monday with a crazy-busy oncall, and just after I had got back from handover (where I make all my patients someone else’s responsibility for the night) I was called to see this patient who was very breathless. When I went to see him he was breathing hard and grabbing my arms yelling ‘you have to help me, I can’t breathe’ but all I had time to do was scream for some morphine and my registrar (who I’d had to call in from home earlier about another patient who had dropped her GCS from 14 to 9…freaky), crank up the oxygen to 15L and drop the bed flat before he arrested and I was yelling for the arrest call to go out. We did CPR for 45 mins but he died. It was my first arrest, it was so fast, and I was so upset, I spent like half an hour crying in the treatment room.

I talked it over with my ultra-calm registrar (I love him) who assured me I did everything right, we all did, and there was nothing we could have done differently which would have changed the outcome. Did I mention I love him?! Nothing is so scary when he’s around, he’s so calm and I get so flapped, while I’m busy freaking because someone’s BP is 80 systolic he’s like, ‘it’s fine Jo, just give some gely‘ and I’m like, oh yeah, I remember I know how to do that, why didn’t I think of that?

The week didn’t really get any better, we had another very unexpected arrest on wednesday night, though after I’d gone home, and last night was a 4-admissions-after-7pm night, which scuppers your plans to go home on time somewhat. So it’s been a bit mental really, and I’m appreciating the weekend more than I ever have before I think. I’m still in my pyjamas, it’s nearly 2pm, and my bleep is safely at the hospital where it can’t bother me.

I was discussing working life with another of the F1s last week – it’s amazing to find out that though we all look calm and in control at least most of the time, inside we are all totally out of our depth and terrified of doing something wrong and getting shouted at! It’s good to know I’m not alone.

Got a few days off next week, I’m going to Loch Lomond-shire with a friend for a couple of days – she’s been in Japan for a year, I can’t wait to see her – so that will be nice. I have to work monday first though

Hopefully I’ll blog about something less medical soon, apologies for the shop talk of late. Here’s a joke one of my seniors told this week to end on!

How many orthopaedic surgeons does it take to change a lightbulb?

…………just one – Dictation: Room dark. Refer medics.

Exhaustion…or how I learned that medicine is a game

Well, that’s me finished my first 8 days of work…I calculated that I’ve worked 86 hours since last friday which is rather a lot if you ask me, and I’m ready for my day off now!

All in all, I’ve really enjoyed it. I’m starting to think it’s some kind of crazy game. Here’s how I see it:

Go to work in the morning – get handover. This determines the difficulty of the game that you start at. Lots of sickies = advanced, nothing to report = beginner.

Level 1: The Ward Round – see all patients before moving onto next level. Complete menial tasks for points, insert venflons for more points, review sick patients for bonus points.

Level 2: Complete ward round jobs. More points to be had by knocking down obstacles such as fluid prescribing, rewriting kardexes and things. Go back three spaces for a tissued venflon.

***Congratulations! You have prescribed meropenem, at £100 a day! Win a free lunch from a drug rep***

Bonus Level 3: Lunch. This is a difficult level to get to and is not reached every day.

Level 4: Get called to see a sick patient. 500 bonus points for not killing them, 100 points for correct investigation and initial management, 100 points for diagnosis. Lose 500 points if you have to send them to HDU. Lose 1000 points if you have to send them to ICU.  Game over if you have to send them to the morgue.

…anyway, you get the picture! Some days you win, some days the hospital beats you. I won a couple of days this week, but other days I lost. A couple of people got really sick, a couple are dying, we had to tell 5 that they have terminal cancer, and on one day my (male) consultant and my (male) registrar between them managed to make 4 ladies cry in the course of one ward round – enter me with tissues and sympathy while my reg and consultant stand there looking awkward and saying ‘there, there’ in a very male way.

So it’s been a rollercoaster, but I’m feeling good. I’m starting to recognise when people are properly ill, I’m not panicking about every little thing, and I’ve stopped freaking out every time I prescribe a scary drug – warfarin and insulin are not exact sciences, I find, and I even managed morphine and benzodiazepines a few times this week!

This weekend I have lots of nice things planned, including taking the medical students out for lunch, seeing a friend from uni, and playing my violin at church. I’m looking forward to it.

But most of all, I’m looking forward to going to bed!