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Diary of an FY1 – First Days

September 24, 2014

The following was written for the “Diary of an FY1 Doctor” column in the Medical Student Newspaper. It seems only fair I share it here too.

You can always spot a medical student when you’re out and about. The nearly-ironed trousers, that stiffened, anxious way of walking, the glint of what is surely a stethoscope stuffed hastily into their satchel. These are more reliable indicators than even large neon signage.

It turns out these signs are also pretty good at picking out newbie doctors. Late in July, I followed one such example to the hospital where we were about to start shadowing. It was like looking in a mirror. After six long at medical school, I had somehow convinced people that I knew enough medicine to be let loose on the general public. The spectre of outrageous fortune, in the guise of the SJT and FPAS, had discharged me to– Actually, let’s not get into specifics. Let’s just say I have arrived in a pleasant district general hospital somewhere in the leafy exurbias around London. Let’s call it St Elsewhere’s.

So I started at St Elsewhere’s in July for a week of shadowing. This grace period gave us the chance to learn our aspirin from our enalapril, to learn where to get to best coffee in the hospital and where the most secluded supply cupboard is for that necessary first day breakdown. It was also an opportunity for a thoroughly anaesthetic series of lectures. On the plus side, I now know how to correctly lift a box.

Shadowing also gave us a chance to meet the outgoing FY1s. They were all very friendly, attractive and effortlessly competent in their (soon-to-be my) job. God, how I hate them. Still, it is reassuring to know that is what we will look like in a year’s time.

The FY1 who I am to replace gave me his biro. It was a totemic gesture, a handing down of responsibility. With that pen, he was saying, “These are my patients. Love them as I have loved you.” A sacred and professional bond that cannot be broken. Left speechless with emotion, I accepted with tears in my eyes. I think I’ve lost that pen now.

All too soon, the first Wednesday in August rolled around and the training wheels fell off. And yet, it was all very gentle. The registrar who led the ward round spoke slowly just so I could keep with the note-taking. For doctor’s writing, chickenscrawl is acceptable but to be slow is a sin. His pity only went so far – By the time I had returned the notes, the rest of the team had left the ward. Survival of the fittest, I guess – Or was it something I said?

After the ward round came the jobs. Working on a small urology team means we don’t have many patients and those we do have are mostly pretty well. Thus, the jobs were, dare I say it, manageable. Although, I do wonder how well six years of medical school prepared me for byzantine layers of administration and paperwork. Maybe I missed the lecture about bleeps and pagers, or the PBL session on using Windows 98 for everything.

Bleeps are a fun thing. It quickly becomes a Pavlovian response to look down at my belt loop whenever a bleep goes off. It’s not just bleeps either. The mess microwave pinged that someone’s lunch was ready and all the junior doctors present instantly looked down. The topics you get bleeped about are equally diversionary. It’s either a wrong number, a decision far above your ahead or that you already documented that morning. Oh, and “This patient’s systolic blood pressure has dropped to 40…is that bad, doctor?”

Outmoded computers and pagers I can handle but I draw the line at fax machines. Why are they still a thing?! I think they might be my nemesis – if you make a mortal enemy from office equipment. There are surgeons out there operating with Google Glass and I’m sending email down a phone line. In my final year of medical school, we were given clinical iPads – Now I have to work with technology that reached its zenith in the first act of Die Hard 2.

Having said that, communicating with departments that only accept faxed referrals has given me a chance to work on my penmanship. I filled a page with cramped prosaic chickenscratch to politely ask for a clinical review. When I put the paper down, I knew I had created art. My new FY2 laughed at my naiveté – an arduous FY1 year had crushed his sense of wordcraft and freedom of expression. The SHO who came to review our patient remarked that it was a very lovely referral – the equivalent of a Pulitzer in my esteem.

In fact, all the staff have very kind to us newbies. They can obviously spot the fear in eyes, and smell its stench from two wards away. The nurses have long perfected that combination of matronly concern and pity. The pharmacists have been very conscientious in phoning me to list all my mistakes on the drug charts and TTO orders in the vain hope that I will make fewer mistakes next time. But it’s the microbiologists who are the epitome of patience. Hidden away somewhere in the hospital, they wisely explain all things bacterial and antibacterial. “I can see you prescribed co-amoxiclav. You chose…wisely.”

It has been a turbulent few weeks but I am grateful that this beginning has been calm enough, in brief moments, for me to find my feet. It was a pleasant surprise to find I had survived my first day as a doctor, and so had my patients. Being called “doctor” is still very, very weird. It might be going too far, especially at this early stage, but I feel I might be becoming less incompetent with every day that passes.

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