Anna Allan: Acclimatisation to the NHS

My fellow FY1s and I have been flying solo for over three months now. It has been filled with “firsts.” First day of work, first night shift… first pay cheque. All exciting milestones in their own right, and each followed, perhaps naïvely, by a sense of achievement having surmounted such momentous obstacles. Time has sprinted by, as demonstrated by my radio silence on the BMJ blogs front. What little spare time I have seems to be spent on my new favourite pastimes: eating and sleeping. However at time of writing I have foregone these two pleasures as I find myself in an almost heavenly lull during my night shift.

Now, at close to 3am on a chilly October morning, the eerily dark, silent corridors feel oddly comforting. Wandering through the empty hospital gives an ideal opportunity to think back over the events of the past few months. I remember my first day vividly. People who know me well may find this hard to believe, but I was the first doctor there. By half an hour. Excited, nervous, and finally unable to hide behind the protective shield of “medical student,” I was almost enjoying myself. I spoke too soon. “Doctor, one of the patients had a seizure this morning and now has chest pain.” An ECG was thrust in front of my face. “What do you think?” Words cannot describe the thoughts racing through my mind at that point. Fear would probably be a good starting point, particularly as there were no doctors on the ward yet. Apart from me. My only consolation is the fact that, having discussed the first few days amongst friends working in hospitals up and down the country, I can safely say we have all shared very similar experiences.

Thinking back to the first few weeks, all the ward days seem to merge into a surreal blur. Learning how to use the computer systems, order tests, even create a handover list, all seemed daunting and fraught with difficulty. However, after being tackled once or twice, the paperwork became relatively self-explanatory. I began to describe myself to friends as “a glorified secretary”: chasing blood results, requesting imaging, writing discharge letters. However, something that has hit home rather hard is the sense of ownership: personal accountability for my patients. It is probably one of the first things that scared me when I first began. That and the fact that whilst patient care is a team effort, as the most junior member of the team, if I don’t do something no one else will. Consultants and registrars assess patients based on their vast clinical experience, but the investigations they request do not happen intuitively. Through this realisation I have finally understood that the hours my fellow FY1 colleagues and I spend on these “secretarial” jobs, whilst occasionally bordering on the mundane, are also essential.

Since falling down the NHS rabbit hole, I have learnt a few things which have changed my working life for the better.

1.    Lists: Yes, they are depressing, daunting, and dull. However once you realise that this scrap of paper is the only reminder for you to book a test or chase a scan result, the humble list is suddenly propelled up the ranks to a position higher than that of the stethoscope. Woe betide those careless enough to lose such a precious treasure!

2.    Nutrition: I started out ward life working through lunch, skipping those precious 10 minute breaks during which I formerly used to take sustenance. Ignoring advice from other doctors, I struggled on… until the realisation dawned that by starving myself I was doing no one any favours. My patients were more nutritionally replete than myself as I wrote vitamin supplements and nutrition drinks on their drug charts through my lunch breaks. The irony was lost on me. The situation only worsens on night shifts, where it is not uncommon to go 12 hours with 0mls of urine output. If I were a patient, I would have had more than my fair share of stat bags of gelofusin by now. I have taken to carrying a bag stuffed with food and water wherever I go. Certainly not rocket science, but it has upped my productivity ten-fold.

3.    Time off: Unwinding and leaving hospital problems behind is probably the hardest thing I have had to overcome. The sudden fear, sitting bolt upright in the middle of the night, worried that a job was forgotten during the last busy shift. Luckily the hospital is a 24-7 machine so if you really have forgotten something, regardless of day or night, someone somewhere will be able to ease your mind. But learning to let go during rest days and taking advantage of precious time off is difficult. Whether it’s dinner with friends or a holiday abroad, the most important thing is to have a plan. Even if it is a plan to do nothing at all.

And as if the fates had heard my final words penned, my bleep breaks the silence.

Anna Allan recently qualified as a doctor. She graduated from Gonville and Caius College, University of Cambridge in June 2012. She began her foundation year rotation in the North Central Thames deanery.