My first day as a doctor

Authors: Omar Barbouti, Nida Gul Ahmed, Clinton Vaughn, Ali S Hassan, Tabassum A Khandker, Yasmin Akram 

Publication date:  26 Aug 2009

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This year’s doctor intake started their first jobs earlier this month. Omar Barbouti and colleagues give an account of their experiences

Omar Barbouti

My alarm clock rang at 6 am. I automatically slapped the snooze button, having been used to getting up at around midday for the last month. In fact, I had just got back from a long vacation with my family and was still slightly jet lagged. Ten minutes passed and the dreaded alarm went off again. I lay there for a few minutes thinking; I had put work and medicine to the back of my mind while on vacation, but reality started to kick in. I felt my heart rate go up and I got a burst of adrenaline that made my stomach feel like it was doing cartwheels; it was the same feeling I had before finals. I thought about what this day meant—the first day as a doctor, the first day of my career, the first day of not being able to say, “I’m just a medical student.”

I got out of bed, had a shower, and got ready. I didn’t eat any breakfast. I drove across south London, arriving an hour later at the hospital. The first part of the day involved meeting the other new doctors, then lots of paperwork, and health and safety lectures. After an IT training session I was sent to the ward, where I arrived feeling nervous, like a medical student on the first day of a placement. I located the house officer I would take over from. After a long conversation about the job, what to watch out for, and what to expect, she gave me a brief handover. She then handed me the bleep—this felt like a defining moment, like I was being given the baton in a relay—and I was now responsible for 15 or so inpatients. The day ended, and as I left the house officer told me that the ward round would start at 7 30 am the next day.

I drove home that night, slept early, and arrived early the next day and met the consultant and registrar. After very brief formalities they got cracking with the ward round. The senior house officer was due to start the following day so I was on my own to guide the ward round; however, they were easy on me and didn’t expect me to know much about the patients. After I had written up all the notes and ordered bloods, several nurses approached me in turn with requests, “Doctor, we need fluids for Mr B.” My mind went blank—all those lectures on fluid balance and I still couldn’t think of what to give. I froze for a few seconds until the nurse suggested I prescribe normal saline. I then had a moment of genius and decided to check the patient’s urea and electrolytes, which were normal, and hey presto I wrote my first prescription. The rest of the day was hectic—as soon as I finished one job, I would get another bleep from a nurse requiring a cannula to be sited or a drug chart to be rewritten. I decided to get organised the following day and came in with a clip board.

I was on call the very first weekend. I was bleeped by the radiology department, who wanted a doctor to be present as they administered contrast for a computed tomography pulmonary angiogram. When I arrived a technician said, “There’s the box with the anaphylaxis equipment.” I stood there, thinking to myself, “I’m actually a doctor, I’m not here just to watch, this is it.” And so began my career; I look forward to my next day and my next challenge.

Nida Gul Ahmed

As I approached Lincoln County Hospital for my first day on the job as a foundation year 1 doctor (F1), I experienced a variety of emotions. I couldn’t wait to get started and felt all the excitement that only a first day can induce. I felt nervous, responsible, and apprehensive. Questions such as “What will be expected of me?” and “Will I be able to do the job well?” kept cropping up in my mind.

My first rotation was in critical care, involving time in theatre with the anaesthetists and in the intensive care unit. I appreciated having had two weeks of shadowing before starting F1 and it helped take the edge off my nerves. I had fond memories of an enjoyable anaesthetics attachment at medical school, and ever since had considered a career in anaesthetics. Having critical care as my first rotation was a privilege.

The day started at 8 am with a morning trauma list. I introduced myself to the consultant anaesthetist, who was very friendly, and I felt the tight knot in my stomach ease slightly. The first task of the day was to see patients for pre-anaesthetic assessment. I assessed two patients and enjoyed myself immensely. Once the patients were brought to theatre I was asked to cannulate them; the fear of messing up cannulation on my first day under the eyes of an expert was immense. However, it went smoothly (phew), with the consultant giving me some very helpful tips throughout. It was a great morning with lots going on: I inserted laryngeal mask airways and also helped to monitor the patients intraoperatively.

In the afternoon I went to gynaecology theatres. The operations involved spinal anaesthesia, and the first question the anaesthetist asked me was, “Would you like to do the spinal block?” I just looked at him in shock, having seen many but never done one myself. It was such a great buzz to do something so exciting on my first day. I observed the first one and on the second was watched closely during the procedure. When I saw droplets of cerebrospinal fluid emerge through the needle, it was exhilarating.

It is definitely worth all those hard months of studying for finals to be at the other end doing the job of your dreams and to be learning something new every day.

Clinton Vaughn

Thursday came: the day I started work.

My on-call bleep went off at about 11 am saying “cardiac arrest.” My heart stops and I listen intently—where is it? How do I get there? It’s muffled and then I hear—“testing.” My heart slowly descends from my mouth.

I set off to the wards. My senior house officer is out of action because she has to go to her own induction. My friendly registrar leaves me with only four drugs to take out (TTOs) to do. Simple, right? Then I learn about the people in blue uniforms who ask you to resite cannulas. It’s fine because they all go in successfully, hurrah. “Now back to the TTOs,” I thought, but my med student then tells me that one of my many patients (who, by the way, I have no clue about because I have never met him before) is desaturating and breathless. I order four litres of oxygen on nasal prongs and happily watch his sats go up to 97%. Even so, he is still faint while I try to cannulate him. My specialist registrar does an arterial blood gas—“What’s the result?” he asks. “I think the sample was venous,” I reply. My med student then reminds me that it’s type two respiratory failure. Am I going to have to get used to students knowing more than me?

The day trundles on and I still have not done those darn TTOs. I get to work but then discover how slow and inefficient I am at doing everything—never mind TTOs. One five minute job takes 30 because I keep rechecking everything, fearing that I have made a mistake.

The nurses tell me that a family member wishes to speak to me about her mother, at which point I shamefacedly admit that although I am looking after her mother I know nothing about her history so I ask her to wait for my registrar, who is on call.

5 pm. I still have not completed those TTOs. The patients now have to wait until tomorrow for the pharmacy to dispense the drugs, and hence they have to stay another day. I don’t care at this point. I want to go home. Will I ever be good at this?

The on-call bleep switches on: “That’s a crash bleep; you need to answer it,” another specialist registrar tells me. “Is it really a crash call?” I reply. “Yeah, definitely.” I call the number. I’m tense. As it is ringing the reg smiles and says, “Only joking.” “That’s not funny.” “Yes it is.”

The on-call jobs come. Not too bad at the moment. Most of them are low priority until finally I get a call from another F1 to review a patient with haemoptysis. Thank God for ABCDE. I start oxygen, take a short history, listen to the chest, check obs, whack a cannula in, and take some bloods. I’m worried that it could be pneumonia or a pulmonary embolism. Feeling clever I ask the reg on call whether I should start prophylactic dalteparin.

“No ‘cos she’s got a brain tumour,” he replies.

Feeling a bit stupid because my basic science took a nose dive I check the patient’s chest radiogram. It looks like consolidation. I then go to handover. The time is 9 15 pm.

It’s handover and I have not stopped; I’m literally running on one chocolate bar. After mumbling that I’m only an F1 who knows nothing, the night F2s respond with a genuine empathetic “aww.” I retire to bed. But I still can’t stop thinking whether I did the right thing for my patients.

They’re still alive the next day (thank God). I am too. My aspirations of becoming an emergency medicine consultant are also alive. For some strange reason, I can’t wait for the next on call.

Ali S Hassan

Having already shadowed the former F1 for a week, I felt gently eased into my first day. This was a great relief because it could easily have been more like a cold plunge. Most of the staff on the unit already knew me, and I knew the current patients and why they were there. The downside to the week’s shadowing was that I had seen just how good the previous F1 was, and had been told that I had a hard act to follow.

I knew to be in for 8 am; I knew there was a meeting at 9 am and where it was; I even knew how the particular consultant on that day liked his ward rounds to be run. What I didn’t seem to know was any medicine. I felt that during the time between finals and starting my job all knowledge had seeped from my brain—to be replaced with dysfunctional doubt and fright that I might do or say something so thick that all confidence in me would be lost instantly.

I started on the same day as a new senior house officer so I knew more about the running of the unit than her, which was a double edged sword. Although it made me feel like I knew what was going on, when I didn’t know something there wasn’t that experienced senior house officer to fall back on. Luckily she had worked in the same hospital for the last year and so she knew her way around—this was to prove very useful when my bleep yelled out “cardiac arrest Foxbury ward.” Of course having no idea where Foxbury ward was or how to get there I would have gone to reception.

All the staff at the unit were very sympathetic to the fact that it was my first job—probably because I reminded them so often. The intensive care nurses are highly specialised, so they were able to translate the mass of blinking screens and digits that surrounded each patient and explain where the many tubes and lines came from and what they were for. This was another great relief as my medical course had covered very little about intensive care medicine.

My feelings of ineptitude were only made worse when a nurse handed me an electrocardiogram and asked me what was wrong with it. The longer I looked at the black scribbles against the pink background the more awkward it became. I don’t know why but I seemed to forget all basic principles—I opted for the easy way out saying I’d like to show it to the senior house officer for her opinion. I kicked myself when she pointed out the glaringly obvious ST depression. There is just something about the pressure of being expected to know that seemed to make me crumble—having to assume authority is probably the biggest leap from medical student to doctor. I imagine everyone experiences it to some degree and the only way through it is the exposure that an F1 job gives.

Tabassum A Khandker

By the time I started my first day on the paediatric ward, I was confident about my job and abilities; I had shadowed the departing F1s for one whole day, attended induction and acute illness training, and knew where the wards were. This confidence was then destroyed when I was told that the previous F1s were the best the consultants had seen, and had worked to the level of senior house officers.

I began work on Wednesday with two other F1s in paediatrics; we were promptly separated, and one person went to the neonatal intensive care unit, one stayed on the paediatric ward, and the third covered paediatric accident and emergency and the ward. The F2 and senior house officers were having corporate induction and were absent on the first day, so I felt very exposed as we wandered behind the consultant and registrar looking lost. After introducing ourselves to as many of the nurses as possible, the pharmacist, and anyone who walked on to the ward, we became more comfortable; at least people stopped looking suspiciously at us. We were lucky because the medical students were nearing the end of their attachment, so were doing our jobs better than we were, and helped orientate us on to the ward and computer systems.

During the shadowing day, a team meeting turned into a pub quiz and this helped the new F1s to bond with some of the consultants and registrars. I realised that in paediatrics the consultants and registrars are very involved with patient care and very willing to share their knowledge, however basic my questions. This impression was reinforced during my first day because everyone patiently explained what to do, when to do it, and whom to contact if I was still confused. This period of grace doesn’t last very long in other departments apparently, but I’ve heard that paediatrics is different—I hope that will be the case.

My day involved writing notes on the ward round, ordering tests and checking results of previous tests, and, of course, the dreaded TTOs. After stumbling through my first one, I have become faster and more confident about completing them. For me the golden rule is to look up every drug I prescribe for children because children are very different from adults, for whom there may be standard doses for certain drugs. I make no assumptions with children and drugs, although that may change with experience.

By the end of my first day I felt enthusiastic and confident about my rotation in paediatrics; the team were very supportive, my role in the team seemed clear, and the more involved I was the more I got out of my day. The fact that this rotation is unbanded without on calls or weekends, may also contribute to my job satisfaction.

I have been told that these few weeks are the lull before the storm: soon schools will restart and the next wave of people with swine flu will grace our wards—so who knows how I’ll feel in a month or two?

Yasmin Akram

Having made the autocratic decision not to spend any of my last long holidays shadowing for my new job I was cursing my stupidity as I met my fellow F1 in paediatrics, who sensibly had shadowed. As we walked through the hospital she knowingly greeted staff while I looked on sheepishly like a child who hadn’t done her homework. With the butterflies running riot in my stomach we knocked on the consultant’s door; he greeted me by my name. At that point I wanted the ground to open up and swallow me whole: my paranoia was telling me the only way he could have known my name was because I was the troublemaker who had emailed demanding her rota so she could organise it around her life, even before she had started work. Had I forgotten that medicine was not a job, but a lifestyle?

But having feared the worst, I found that the consultant was jovial and welcoming. He immediately recognised me and put me at ease, and I prayed that the rest of the people in the department would be as nice.

Then on to the wards. As I took histories I was surprised that differential diagnoses were running through my head; I actually remembered something! Having half expected to be a glorified medical student, I realised that something had changed; although I was well supervised there was an increased sense of responsibility, brought on by the faith that patients and colleagues put in me. Additionally, I realised that I receive automatic respect from medical students simply by virtue of the fact that I am on the other side of finals to them. Getting them to do jobs for me could easily be a mini power trip, except in the back of my mind there is the constant reminder that their theory is probably fresher than mine, given my long, mindless, shadowing-free holiday. Also, not long ago I was in that position myself, and I honestly appreciate their help.

As the day went on I had moments of panic and disorientation, but also satisfaction at micro achievements such as successfully taking blood from a wriggling and screaming two year old. I also slowly picked up the lingo; finding out what is meant by “a capillary” and “a heel,” for example. I finished my shift exhausted, although after votes of confidence from my seniors and generous offerings of chocolate and biscuits I was looking forward to my next day at work, but only going home and collapsing on the sofa for a while. It was a long day.

As for the future? Indeed, medicine is not just a job, but a career. For now I’m finding my bearings, taking it a day at a time.

Omar Barbouti foundation year 1 in general surgery  Princess Royal University Hospital, South London NHS Trust, Orpington, Kent
Nida Gul Ahmed foundation year 1 in critical care  Lincoln County Hospital, United Lincolnshire Hospitals Trust, Lincoln
Clinton Vaughn foundation year 1 in care of the elderly  Kingston Hospital NHS Trust, Galsworthy Road, Kingston upon Thames, Surrey
Ali S Hassan foundation year 1 in intensive care unit  Queen Mary’s Hospital, Sidcup, Kent
Tabassum A Khandker foundation year 1 in paediatrics  St Peter’s Hospital, Chertsey, Surrey
Yasmin Akram foundation year 1 in paediatrics  Good Hope Hospital, Heart of England Foundation Trust, Sutton Coldfield, Birmingham

 obarbouti@doctors.org.uk