The musings of a junior doctor

Sunday, 15 September 2019

My first month as a doctor

On Wednesday 7th August 2019 I began working as a doctor. I work in a small district general hospital on an acute medical ward. This is a summary of how the first month has been! 

Baptism of fire would be an understatement. My first day I was working a normal 8-4 shift on the ward, except the consultant was on annual leave, so we had a locum who like myself was entirely na├»ve to the software and general running of the hospital. It was myself, two consultants and two other FY1 doctors. The ward has no permanent middle grade or registrar doctors, and given the acute nature of the ward it means that the rounds are meant to always be consultant led. This has definitely been a huge help on my first few weeks knowing that although there are few people to delegate jobs to, there's always a senior to speak to. Except when one day we had no consultant cover and nobody knew, including the ward sister. 

After that first day I was quite shaken up. I felt so wired with adrenaline and couldn't really sleep. The second day was pretty awful. I was so relieved when Friday came and I knew I had a weekend to recover. I felt guilty for feeling so wrecked when I had only worked 3 days - how could it be that bad? On that Sunday night I had such dread about going in the next day. Slowly things started to click and make sense. I am becoming quicker at doing the jobs.

My first patient death was a slap in the face. Although it was expected, I was shocked and extremely upset. I had to leave the ward to cry, and not just a little cry. It really struck me how little some people seemed to care about patients having a 'good' death. Why didn't everyone care about having those conversations about resuscitation, just in case medicines and preferred place of care?

I then had a week of being on take clerking patients in A&E majors, and a few night shifts as the FY1 doctor covering all of 'back of house' - all the medical wards. My biggest challenge in those first few weeks was my panic and anxiousness, which made it really hard to think systematically. It was easy to catastrophise problems that weren't really that significant. I found it so hard to do a proper SBAR hand over when I was feeling so anxious, heart racing and mouth dry. I would crave a coffee but knew it would make the anxiousness worse. 

Nights were good and bad. I had quite a spectacular end to my first ever night shift: a patient who had a pericardial effusion rapidly deteriorated. I called the med reg, then the anaesthetist came, the call went out and a cardiologist drained the effusion on the ward and took the patient to ITU. All at 5 minutes before handover. Again, it was so hard to sleep whilst feeling so wired from everything that had happened. I cried to my SHO before starting the next night shift, I felt so out of my depth. They had a quiet word with the med reg and they both supported me so well for the next two shifts. 

It can be quite hard to stay on top of admin work and also have time to look after yourself. I have not been exercising enough because I mostly seem to come home, eat dinner and crash into a heap on the sofa. I've been able to eat regularly, but not always the healthiest choices. I have struggled to be present when I'm with my loved ones; wondering if I remembered to do XYZ or what will work be like tomorrow. I am trying my best to remember to be grateful, use the Calm app and still practise my hobbies. 

I am not saying all this because I resent my job - I love being a doctor. Overall, I am really enjoying the experience! I know there are many juniors who have it worse off than I do, but I think it's important that we can be publicly honest about the reality of the job. I am slowly embracing, even enjoying the madness and frenetic nature of the ward. I really like my team. I laugh and smile every day. I am so grateful to have this job. 

1 comment

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