To think like this again...

1^st August 2007 (11.34 pm). My first day as a doctor.

I might as well write about my first day as a real, live, paid, working doctor. I started off in A&E basically, right in the front line, and it went okay but I feel so humbled in front of patients. My first real patient ever was a Mrs.*****, a 69 year old lady who had chest pain and has a long history of cardiovascular problems, including a previous MI and a CABG and an angioplasty. The blood supply to her heart is obviously poor despite all this, so I essentially had to, with some support, work out what to do about this. I prescribed clexane, clopidogrel and some pain relief, and wanted to check troponins at midnight, which I’ll look up tomorrow. ECG didn’t look like an MI. But anyway, it was strange today, being called “doctor” and talked to with respect by a patient for the first time ever really. As a med student, you get treated nicely but this lady was really very nice to me and I really wanted to help her; I even held her hand walking her to the X-ray and got a few strange looks from the staff/other patients for doing so, but fuck it, she was old and had pain in her legs. I’d like a doctor who did shit like that for mum etc if it came down to it.

I’m not sure what I felt at the end of the day; I sat around in the pub with a couple of other doctors having a few drinks and I think we all found the first day a bit weird but strangely satisfying, despite the amount of stupid things we all had to ask everyone. It’s mainly about getting used to the way things are run and where things are kept, but I still need to revise my medical knowledge. As for my patient, I’ll check up on her tomorrow when I can. I’m on-call tomorrow which might be tricky. It’s all about calmness and composure. I was called to a cardiac arrest today for some reason but didn’t really have to do anything luckily. But tomorrow I might have to be the main medic running the show, or at least one of three.

Friday 24th August 2007

Another night…I’ve been a doc for about 3 or 4 weeks now. I’ve had to deal with a few rough situations lately; declared a patient dead for the first time in my professional career this week –

I thought it would be ok, thought I’d just go in there, clinically look at the body and walk out. In reality though – there’s a dead man lying there. Fresh bruises on his jaundiced body. I feel toneless limbs, look into unresponsive, dilated eyes that are stained with dull red blood starting to clot. The expression on the man’s face doesn’t change. He’s dead. It’s scary – and I scribble my entry in the notes quickly, mumble a declaration to the charge nurse and hurry to the nearest toilet. I don’t puke, but I’m kind of tachypnoeic and a bit flushed, and have to spray my face liberally with cold water to get a hold of myself. Then the next day, another patient of ours starts to go off, and I’m in the thick of it this time, doing chest compressions; apparently my compressions restore an output, but he dies later. His wife and daughter hold his hand whilst we ventilate, and I realise that this could one day be me, with my dad, my family. I look out of the window, and try to focus my thoughts on causes of sudden respiratory arrest – was it anaphylaxis, a pneumothorax, perhaps a pulmonary embolism? Answer – who gives a shit. It’s a dead man, and his family are in tears. I can’t help but engage emotionally but I’m scared that if I do, I’ll be a shit doctor – and if I don’t, I’ll just be a shit person.

In other news – did my 2nd central line today (with help from ****). Also stuck in another catheter (tricky this time); did another NG tube yesterday. Taken shitloads of blood. I think my practical skills are developing nicely.