A little while ago, I had what I referred to on Facebook as my “no good, very bad, terrible week of epic terribleness”.
It started with a car accident from which I emerged emotionally battered and, in a there but for the grace of God kind of way, physically unscathed. (My car was less fortunate.) To my extreme irritation, my dealings with the various bodies one finds oneself arguing with after this kind of thing are still ongoing, and, until those have been taken care of, I’m not talking about it in Internet public. In fact, I mention it now only because that night, sitting in my car with the headlights exploding in the air, my overwhelming impression was that the world was ending loudly around about me and that, despite my very best attempts, I was absolutely failing to do anything about it. And that is as good a metaphor as I’ve ever heard for a bad medical on call.
The fact that that accident really was followed by the worst weekend on call I’ve ever had is, I think, evidence that the universe has an appalling sense of humour.
I’ve said before that if I’m on call, I’m covering four wards and 128 medical patients. In August, I had just about wrapped my head around the idea of doing this in the evenings, for three hours at a time, when all of a sudden I had to do it for the whole weekend. That’s a Friday evening and then all day on Saturday and all day on Sunday, and do please believe me when I say that I am never so happy to see other doctors as I am on my post-call Mondays. My first weekend, I spent two days wanting to crawl into a handy cupboard and have a good cry. I didn’t, but only because I didn’t have time. At one point, I had two patients — on, inevitably, two different wards — who both seemed to be actively trying to die. In hindsight, they were doing no such thing, but I was very new and very intimidated and I hadn’t learned yet how to say no or how to get a CT scan done at nine-thirty on a Saturday morning. I held it together, mostly, until the Sunday night, and then my mum called when I was on my way home and I burst into tears right there in the middle of the train.
And then there was the weekend after my car crash, when my answer to the surgical F1 who asked how my day was was a succinct and brutally honest, “It’s shit,” and when I ate a cheese sandwich standing up at a notes trolley at 6.15pm and called it lunch. I wouldn’t have minded, but getting that sandwich required a stand-up argument about why at that particular moment on that day, buying something to eat for myself was, yes, actually, more important than prescribing a nicotine patch for someone else.
My experience of weekends on call has been that it is never about dealing with a single catastrophe. It might be easier if it were. It’s about a lot of medium-sized disasters and a million tiny little stresses. It’s about never sitting down. It’s about seriously thinking about flushing your bleep down the toilet. It’s about having everyone be reasonably stable for most of Saturday and then four of them getting sick all at the same time on Sunday. It is inevitably about chasing U&Es for someone whose creatinine is in the high 400s and who is draining what can be described only as brown sludge into their catheter bag and then realising that they are still making more urine than all the doctors combined. It’s about nursing staff who, in the beginning, when you’re new and not yet trusted, seem to think that if you’re not on their ward, you must be in the canteen — but, a few months in, if you’re lucky enough to have wonderful nurses, it’s about the ones who have learned that your name isn’t “Doctor” and who, when you do turn up on their ward, give you three warfarin charts and a cup of tea and two custard creams. It’s about feeling suddenly very very alone.
And it’s about beginning to learn how to be a doctor.
Because in August, I didn’t know these things. I didn’t know how to get a CT scan done at nine-thirty on a Saturday morning or who to get a urology opinion from at six on a Sunday evening. I called my SHO a lot, because I didn’t trust my own eyes or my own ears. I still call my SHO a lot, but not for barn door hospital acquired pneumonia anymore. And, a little bit at a time, I’m learning when to say no.
The learning curve this year feels a lot like walking up a sheer cliff face in heels. Backwards.
Or, on the bad days, like sitting in a car with headlight glass shattering in the air around about you.
I’ve come to the end of my F1 medical on calls. The mysteries and horrors (and joys and delights) of receiving weekends and surgical long days await, but the next time I do a medical weekend will most likely be as an SHO. And now that those weekends are over, the wonder of it isn’t that I survived — although, it’s that too. The wonder of it is that I’ve come out of them battered and dented and sore, but, yes, against everything I’d ever have believed on that first Saturday, a better doctor because of it.