Diary of an FY1: Stories

[box] This month, Rhys flirts with running away to a bookstore but realises he is already awash with stories [/box]


Winter has finally thawed at St Elsewhere’s and the change in season has brought a change in scenery. As the sky brightens and the daffodils bloom, I am swept down from the glacier of my respiratory ward eyrie, carried by meltwater, to my third and final job of my first year as a doctor. Haematology, bloody haematology. Gone are the creps and wheezes I had grown to love, replaced by the legion forms of leukaemia, not to mention the complications and consequences of treating our patients with poison on a daily basis.

And, dear reader, it is fantastic! Every day I am learning something new – about cancers, about drugs, about those little red and white corpuscles. I don’t think I’ve learned this much since medical school. That my new registrar regularly buys me coffee and steals biscuits from the tea trolley for us is an unprecedented joy. I think I just might like it here.

It’s weird to think that I’m two-thirds through my first year as a doctor. I passed my exams nearly a year ago but it took six months of people calling me doctor before I believed it myself. Now, I’m nearly ready to believe that I can be a good doctor for at least some of the time.

There have been times where I’ve wondered if medicine is actually worth it. Disastrous on-call shifts when I just couldn’t keep up with the onslaught of bleeps, the harpy at my belt. Times where I’d relish a little breakdown in the clinical room – except it’s a strange new ward and no one will tell me the door code. Then there are times where everything goes to plan, but there’s just so much that I come home four hours late and too tired to think. In the times like these, I’ve wondered if I could pack it all in and run away to join a travelling bookstore. To sell books and be surrounded by stories for the rest of my life.

But the sun comes up in the morning, as it must, and things look a little clearer. The long ward cover shifts of the soul are the price to pay for a job that, for the most part, is a lot of fun. When I was applying for medical school, I’m sure I uttered something about being fascinated by the diverse pathologies that can grip the human body and the strategies to correct them. Of course, that’s still true – the human body is a hot mess of pathophysiologies. But even more fascinating are the human stories I find myself surrounded by right where I am.

On my first consultant ward round in haematology, we saw a patient who had previously been very sick, terminally so we thought. But thanks to his indomitable spirit (and a beyond-heroic dose of steroids), he had rallied like a latter-day Lazarus. To prove just how much better he felt, he challenged me to an arm-wrestle. After a hard-fought draw, I know exactly what 100mg of methylprednisolone feels like. Since then, he has subjected me to the most alpha-male, life-affirming handshakes imaginable.

Or there was the patient who was readmitted in sepsis after curative chemotherapy. Blood tests were disappointing. The leukaemia had returned with a vengeance. Breaking this news to her was not an easy conversation. “So these blast cells…they’re still around and there’s more of them and that’s why I feel like this?”

Yes, we explained.

“Those little shits.”

Which is, I think, a fitting response.

And a few months ago, there was the patient who could remember his hospital number, his NHS number, and the numberplates of every car he had owned since 1950. On our first meeting with him, My consultant and I were a little skeptical of this claim. Sensing that his magnificent memory was in doubt, he rattled off his healthcare numeric instantly – I had to check the front of his notes but wow, he was right!

It’s all too easy to fall into a routine in medicine. Get in. Print ward list. Coffee. Ward round. Lunch. Jobs. Review bloods. Order tomorrow’s blood. Update list. Get out. It is supremely human weakness to allow the interesting (I saw – and diagnosed – my first case of shingles last week) become the humdrum. But what is humdrum for the patients? Another routine pneumonia for me is a serious illness for my patient, spending days in an uncomfortable bed, uninspiring food, and a twenty-four hour schedule of beeps, alarms and interruptions. It is a week of anonymity follows by weeks of dyspnoea and trying to recall what a normal life was.

Or consider the patient with the acute leukaemia, bone marrow freshly blitzed with the very best poison, comes into A&E with a high fever and on first-name terms with their last remaining neutrophils. Neutropenic sepsis is a complication of chemotherapy, sure, but a recognized one, and expected one. Take blood. Blood cultures. Lactate. Taz/Gent and fluids and we’ll see how we go. For that patient, they go through a very different checklist. Is this it, am I dying now? Please help me. Did the chemo not work? Was it something I did? Help me. Will I ever stay out of this hospital? Who will look after my mum/kids/cat? Help me.

Don’t get me wrong. I love routines. They keep my mind tidy (tidy enough) and let me function. But what is everyday for me can be a life-changing event for my patient. It is so very important to remember that but difficult also. Running away to join a bookshop is a fantasy. I am surrounded by stories and the humans that tell them. But more than that, I am in those stories as they are being written. As I’m beginning to dimly see, one of the roles of the doctor, though one that won’t turn up in a DOPS or OSCE, is bearing witness to those stories.

Medicine, in all its guises and specialties, remains fascinating. Much more than my seventeen-year-old self could possibly have imagined.



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