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Diary of an FY1 – Community

July 12, 2015

It seems hard to believe that I’m eight months through my first year as doctor. Eight months have flown by at Mach speeds. In no time at all, I have gone from optimistic and idealistic final year medical student, ready to heal the world, to a hard-boiled, jaded junior doctor who has seen it all and wish he hadn’t. Well, that’s not quite true. I hope that’s never true. But I have certainly learned and grown since skipping out of the shadow of the Queen’s Tower.

Something I never really appreciated as a medical student was the sense of a hospital as a community. Before, medicine was all about listening to murmurs, sitting through clinics, and digesting textbooks. Now, medicine is more about…surviving? Obviously, that’s why we have furosemide and clarithromycin for patients. But so much of medicine for me is getting by with the help of my colleagues, and helping them in return.

I’ve written before on the hellish Russian roulette that is the on-call shift. The powers-that-be in medical staffing throw together a hodge-podge of doctors every evening, every night, every weekend, from different teams across the hospital. We are the Avengers assembled to protect the hospital from tissued cannulas, spiking temperatures and cardiac arrests. Given that St Elsewhere’s is quite a small hospital, it is no wonder that various shifts have thrown me into permutations with most of the other doctors throughout the hospitals.

Those on-call shifts were the crucible through which our acquaintances were forged and purified, and I will not forget them. There was SHO who rescued me from a series of disastrous cannulas (during my worst on-call shift yet). There was the registrar who, when I was faced with a hypotensive and febrile patient, was more confident in my skills than me and dripped advice down the telephone line with the calm manner that said everything would be ok. And there was the SHO who shared videos of adorable cats to those of us gathered in the doctors’ office, or the Ex-Imperial SHO who eagerly swapped stories with me about the Good Ol’ Days and the registrar who brought us all a bucket of fried chicken to sustain us. It’s all about survival, and there are many medicines to do it.

After the fact, in the sober light of a weekday, it’s hard to believe these shifts actually happened. Or if they did happen, did they happen in a dream, or some alternate reality? Wandering the hospital on some meaningful FY1 job, I will sometimes run into these wayward souls. We share a smile and a hullo and St Elsewhere’s gets a little smaller, its corridors a little warmer.

I feel a similar sense of fellowship with the patients I share my ward with. Certainly, when I am still in the office at half-past seven, typing out TTO orders and discharge summaries, I can relate to the insidious institutionalization that creeps between the patients’ beds, like Stockholm Syndrome in reverse. Then, when my patients are discharged, I can’t help but feel glad. They get to leave! Of course, part of it is that we’ve done the good medicine, that our “hard work” (viz a vis salbutamol and steroids) has paid off.

And then when patients are re-admitted a month, a week later, I feel a reactionary disappointment. Never in the patient but for the patient. I am not enlightened enough to disentangle my ego from my medicine. Did we fail with the furosemide? Did we muck up with Mucodyne? Most of our patients are embarrassed and apologise for getting sick so soon – the first day’s treatment is largely disabusing them of this guilt, reassuring them that capricious fate strikes against all of us.

Sometimes these re-unions are sadly one-sided. I spotted a patient who we had discharged on Monday in the mortuary on Friday and my heart sank. Medicine is all about surviving, but the catch is that it is always postponing an inescapable truth. While we’re on the topic of community, there are few at St Elsewhere’s who have been so reliably helpful and good-natured than the bereavement officer, surrounded by too many patients’ files in the bereavement office. That she know exactly how I take my tea is frankly bittersweet.

After all this talk of familiar faces, there is one face wish I could see more of.

Speak of me as I am, of one that loved not wisely, but too well. While at medical school, I met a girl who, for some strange reason, dug me. We dillied, we dallied, we dated and now for some stranger reason, we are engaged (It apparently bad form, after asking someone to marry you, to ask why?). This is a fact that continued to make me happy. But here’s my error: She too is a junior doctor somewhere in London, living her own Diary of an FY1.

My working hours aren’t too much to complain about. They still leave me time in the evenings to write this – Lucky you! – but my better half works far harder for far longer. Even though we live together, I barely see her, apart from late in the evening and some weekends, when neither of us are on-call. It seems perverse that several days can go by without saying hello or goodnight to the person who I really really dig above all others. It came as a shock to me but I know what I am. I am a doctor’s widow!

A long time ago, in ancient 2008, in the very first lecture of medical school, the speaker invited us to look to our left and our right. He assured us, he promised us that one in four of us would get married to someone in that lecture theatre. Being little more than teenagers, barely capable of imagining a 2015 without hoverboards, we all laughed. Yet, despite that prescient and statistically sound prognostication, despite the many things that medical school taught us, they never taught us how to live with a doctor.

It’s mostly about surviving.

Written March 2015

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