Remembering those First Moments as a Junior #Doctor #hcsm

At 5 pm we knew the patient load had changed as our “beepers” (aka pagers) started sounding like a cardiac monitor going off so frequently. There were missing orders for pain medication, tissued drips (a drip that was no longer working and needing to be re-done), admissions in the emergency department, patients with abnormal rhythms in the coronary care intensive unit, blood gases needing taken in ICU…..

Division of labor and unofficial coordination became the order of the day as Niamh and I split the work taking on admissions and ward coverage. I remember during that period working out my rate of pay based on the number of hours I did per week (typically 136 hours per week) and thinking that while I understood that I was inexperienced I felt worth a little more than the £1.36 per hour (roughly $2.20 per hour) given that I recall all the critical clinical decisions we made, the CPR we performed, the relatives we had to speak to give them the sad news that their spouse had died.

By Saturday afternoon we had been on call for 36 hours and there seemed no let up in activity. The nights were sometimes quieter but that was a rarity. As a means of coping we split the night with either Niamh or I taking all the calls after midnight (except in the case of a code when it was all hands on deck necessary to cope with the high workload in these events). In one memorable night I remember 23 admissions coming through the emergency department – if I saw my bed it was never for more than a few minutes. The nurses were all familiar with the work load adn they knew when they paged us that even if we answered and said we were coming they would oftentimes have to page us a second and third time as we would answer but then fall immediately back to sleep. As for our performance and efficiency – I hesitate to imagine how poor we were at tasks and what our decision-making would look like if it were assessed. The good news was that there were many experienced nurses involved who did not work the same hours so were not suffering the same chronic sleep deprivation and were checking up on our orders and activities, prompting and intervening as necessary to prevent errors.

By Monday morning we were all frazzled – I’d lost count of the patients and problems we had dealt with, the patients who had died, the admissions and therapies started, and the slew of clinical problems and disasters we had averted. We stopped taking calls but our day did not finish then and for us Monday was a regular working day dealing with the normal workload of admissions, award rounds treatments, and patient management. It was only at 5 pm on Monday evening we finally stopped work and handed our patient cover over to the new on-call team.

There was some solace in the genuine feeling that you were making a difference in people’s lives but much like Deepak Choopra I struggled with what I was actually delivering – was this really healthcare

What of the interaction as defined by Hippocrates

I did not have a good feeling about the interactions – the fleeting exchanges with these people who were trusting me with their lives and the lives of their families. And as technology and innovation continued their march the reality of the practice of medicine changed

The Good and the Bad

I had some great experiences – I had some awful ones and I continue to be part of what I consider an honorable profession and one I am privileged to be a contributing member. In fact, on a recent flight, there was a request for a doctor – a lady suffering from an attack of pancreatitis but fortunately, we were not far from our destination and my contribution was small and mostly not medical in nature helping to control and comfort for the short period of time till we arrived and then hand the patient on to the ground emergency medical staff. That transition proved to be sub-optimal and it was well over an hour before she was taken care of – I stayed of course, wanting to be sure that her care was transferred to the healthcare team on the ground. The following day I received a note from one of the flight attendants that made my day. She had searched for my name and found me and sent a note to the Nuance Web site thanking me for my assistance and complimenting me for my “display of genuine heart”. My contribution was not so much medical although that had played a part in the diagnosis, assessment, and review of treatment options and the course of action. But what had made the difference was compassion – the focus on the person (and in this case there were two people and I ended up helping her companion navigate London Heathrow airport late at night to get her out to the accommodation they had booked). I had never doubted what I would do and was upset for this lady and her companion whose holiday was not starting off well. This is why I did medicine – I wanted to be the contributor, the person caring for the patient. It is this fundamental aspect of medicine we seem to be losing site of – I can certainly accept some blame – I have a keen eye towards technology and the possibilities it offers – but at its heart medicine is about people caring for people and providing the support that in many cases is the difference between a good or bad outcome (at least perceived by the patient anyway). In fact I tweeted something along these lines earlier this week:

People forget what you said and what you did but they remember how you made them feel
— Nick van Terheyden (@drnic1) November 4, 2013

As a guiding light that works for me – hope it works for you too