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Diary of an FY1 – Of Monsters and On-Calls

October 16, 2014

Life as a junior doctor is filled with monsters of all shapes and sizes. My bleep, for example, is a hellish cross between a black widow spider and a particularly cancerous growth that clings to my hip and shrieks at me. Then there is the god of phlebotomy – I always take spare blood bottles when I venupuncture to appease him and ensure bountiful blood-taking for the autumn season. But the greatest of all monsters a junior doctor face is The On-Call.

At St Elsewhere’s, the On-Call takes two forms. During the week, On-Call means hanging around for a few more hours, mopping up the jobs that the other FY1s haven’t got round to doing. Taking bloods, checking chest x-rays, rewriting their chickenscratch drug charts. Or, if there are a lot of patients coming through the A&E doors, you have to roll up your sleeves (roll them up further – bare below the elbows) and get busy clerking. It’s a temporary annoyance, much like norovirus, and lasts for about as long.

Then there’s the weekend On-Call, which is an entirely different disease. At St Elsewhere’s, it’s a hat-trick of Friday, Saturday and Sunday. Friday is like any other weekday On-Call but Saturday and Sunday are at least twelve long hours of solitude each.

My first tangle with this monster came a few weeks ago. Gather round and listen to my tale.

932-3-hospital

Friday. Due to an astrologically unique alignment of the planets, my team finished our ward-work by 10 in the morning. As a gesture of goodwill, I handed myself over the On-Call SHO. He put me to work clerking patients. Looking back, it doesn’t seem possible that they all had right iliac fossa pain and yet McBurney’s here, Rovsing’s everywhere!

Saturday began with a group huddle in the doctors’ mess, with the night SHO handing over the patients admitted overnight. When she left, the registrar, SHO (locum) and me were the sum of all surgical staff in the entire hospital. The registrar and I began our rag-tag ward round of both the on-take patients and the regular (resident?) patients, while the SHO sorted the acute abdomens from the chaff in A&E. Other than make sure they were still alive, and would remain so until Monday, there was little we could actually do. Any imaging more complicated than a Polaroid would require a telephone discussion with the very unimpressed on-call radiologist. Elsewhere, there was only one pharmacist in the hospital so we couldn’t easily order any niche or exotic drugs – Though, as surgeons, we did well enough with just “cef&met.” In fact, the only group of allied health professionals to maintain an effective presence over the weekend was the canteen staff. Their hot food gave me succour for most of the afternoon, even if they boiled all integrity out of their pasta, right down to the atomic level.

If things had carried on like this, that would have been fine. But for one patient on our ward round, the registrar decided that he warranted surgery. Not surgery next week, not surgery on Monday but surgery that day. An incarcerated hernia that the registrar was determined to release. He acquired the locum SHO from A&E and handed me both their bleeps. I’ve already compared my bleep to a tumour; now it had metastasised. He promised me that I wouldn’t have to do anything, just accept referrals and assure that a real doctor would come and see the patient eventually. Swallowing hard, I toddled off to take care of my growing list of jobs.

Here’s the thing about bleeps. Nine out of every ten of your jobs as an FY1 are fine, simple chores. Written out on paper, you look at them and think, I’ll be done in no time. Then the bleeps start coming. You’re halfway through a discharge summary when someone bleeps you about a cannula. You’re trying to site a cannula and you’re bleeped about rewriting a drug chart. And you have to work out where this new job falls in your existing list of priorities. The perfidious bleep-imp ensures that you can’t develop a rhythm for anything. Everything is done in a stop-start staccato fashion. When you are slave to three bleeps, progress moves at a glacial slowness.

But it was fine. That hernia was a small operation. It wouldn’t take long, the registrar had assured me. Two hours and three bleeps later, I was beginning to think that he had been optimistic.

Sunday followed a similar pattern to Saturday but now I knew what to expect. The main difference was that the phlebotomists don’t work on Sundays. I was grateful that they worked Saturday, even they only took “urgent” blood tests (There’s a rush on Friday afternoons as all the FY1s mark all the blood tests for their patients for the next day as urgent. The greatest devaluing of a word since “literally”). With a ward round of around fifty patients, even only bleeding a pragmatic fraction of them soon adds up. No antecubital fossa was safe.

I was glad to keep busy, even with any attempt at flow punctuated by my infernal bleep. St Elsewhere’s on the weekend was really, really quiet. Other than my minimalist team, the only other doctors I saw were the medical and orthopaedic on-call FY1s and they were too ground down to talk much. There was no wit, no badinage to be found. No man is an island, entire of itself; twelve hours of loneliness really wears you down.

Twelve hours is a mean length for a shift, I reflect. Ten hours is mean but I could pull through it. But those last two hours drained me of my reserves more than the ten before them. Maybe I’m a wimp but God bless the European Working Time Directive. That’s how the On-Call monster devours its prey – slowly, cumulatively, with the patience of inevitability. Any on-call that lasts for three or more days is essentially a game of Russian Roulette. Spin the barrel, pull the trigger and…sooner or later, you will lose. Thankfully, I escaped St Elsewhere’s unharmed. This time.

Nolit te bastardes carborundorum.

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