First I was afraid: I was petrified. My first day at work. You are expecting rivers of blood, piles of corpses. What can I say? I am touched, but you over-estimate the importance of the house officer: the dogsbody of the hospital, a paperwork machine, the enforcer of consultants' whims. My patchy medical knowledge has, in these first two weeks as a doctor, proved mercifully irrelevant.
On my first morning, my new consultant, who was so friendly and helpful it was hard not to feel nervous, introduced me and the new senior house officer (SHO) to the registrar, who ignored us all and made for the telephone to discuss a patient in casualty. Twenty seconds later the registrar looked up expectantly; we all fell into line and followed her out onto the ward. I pushed the notes trolley.
During the ward round, the patients were summarised in a sentence, which I scribbled efficiently into my new notepad. I ordered every blood test as it was mentioned, from a stack of blood forms that I had put in the pocket of my new clipboard, and every other job went into the To Do list in the back of my notebook. This all gave me a sense of immense achievement and importance.
The consultant and registrar disappeared after the ward round (they always do; no one knows where they go), and the SHO and I worked at our little lists as morning turned into lunchtime. By the evening, we had almost managed to clear the whole list, but everything seemed to take twice as long as it ought to and require triplication. No one in the hospital bleeped me back when they said they would, my signature became a scrawl, and my handwriting was going the same way. By eight I felt like nothing had quite been finished, but all the other doctors had gone. So, feeling inexplicably guilty, I walked the 10 yards home, had a microwave meal, and slept like a log in my concrete hospital bedroom.
On my second day, the registrar was unsurprised that half her instructions had gone unenacted, but was appalled to see that no one had written up the patients' notes from the previous day (her words of wisdom, our management plan). As I am the house officer (whose job is defined as everything that is not done by anyone more senior) I apologised, and unwisely suggested I could write in yesterday's business today. This is, as they all pointed out, terribly illegal, and the SHO, looking unimpressed, began to write in the notes herself.
The day's jobs trundled by, the previous day's omissions were exposed, and certain recurrent themes began to emerge: the trip down to x-ray (you can send the request form by internal post, but they just ignore it) and being called to do bloods on the difficult patients by nurses, who all make it quite clear that I am walking on the eggshells laid down by previous junior doctors. Sucking up to nurses; filling in forms; ordering x-rays: it was bliss. I knew it was, because I knew what nightmare awaited me that evening.
Ward cover is where they give you six wards, with 120 beds, then everyone else goes home for the evening and it becomes your problem. Perhaps that's a little histrionic. Obviously in medicine your ability to obtain senior assistance is limited only by your sense of shame, and since I know no shame, I am happy to ask for help at every turn. I knew that there was an SHO covering six other wards out there, somewhere on the end of a telephone, but when you answer a bleep on ward cover it is still you alone, talking to a nurse with an ill patient.
I am immediately forced to decide on a doctor's manner: do I adopt a confident yet humble air, that will inspire good faith and cooperation, and read my pocket-sized textbook of medicine whilst hiding in the toilet, or do I risk being mocked by pulling it out at the nursing station? I am delighted to find that I seem to know enough medicine to get by on the minor calls: I can tell when Ibuprofen is a good or a bad idea, I can distinguish the scary causes of nausea from the trivial ones (like hospital food), but I still can't quite bring myself to sign my own name on a drug chart without calling my SHO.
My heart only sinks when I am called to review a delirious patient in liver failure. I read the notes and find that she's been in the same appallingly ill state for the past week, which is a relief. I decide to take some bloods to see if she's getting any worse. It's three in the morning, I dig for a vein, and just as I manage to get one, the patient begins to thrash around. I try not to freak, and hold down her arm, easing the needle out, and trying to remember the golden rule for an impending blood squirt: remove the tourniquet, cover your eyes and close your mouth.
