Diary of an FY1

[box]Anju Phoolchund shows us her optimistic side[/box]

It’s six months to the end of FY1 – where did the time go?  I have not improved my knowledge of medicine sufficiently to become the on call SHO in half a year.  Worrying.  At the same time, I’ve finally come out of the panic-stricken zone of “oh my god I’m going to kill someone, I’m the world’s worst FY1” to learn to appreciate some of the wonderful things about working.  After all, we spend five or six years in a whirl of lectures, exams, trailing behind ward rounds and standing in the corner of the operating theatre, and all we want is to have the title “doctor”.  Finally here I am, and although it’s a bit of a madhouse and undeniably stressful at times, there is something amazing about it.

The nicest part by far about work is the continuity of care that four months of day in, day out on a ward offers.  It takes about 3 days to get to know all the patients on a 30-bed ward, and after that it all becomes familiar and friendly.  Possibly the best part of this is when the patient’s eyes light up a little when they see you as they recognise the junior doctor who took blood yesterday, came to prescribe some fluids or explain the scan results.  On my particular liver ward, FY1s do the ultrasound guided paracentesis for ascitic fluid, which offers huge symptom relief for the poor distended abdomen.  This makes us little “houseplants” (as my reg calls us) very popular amongst that group of patients!

There is also something very approachable about FY1s in general.  Most patients will only see the registrar and consultant once a day at the main ward round, and the rest of the day any knowledge of tests, scans or results comes via the wandering FY1.  We also offer the opportunity for them to ask any questions, or just voice their fears about being in hospital to someone who looks about the same age as their own children.  Last week I spent twenty minutes with a gentleman whom I’d simply gone to take bloods, but who was desperately afraid that he was going to die in hospital, and had just not been able to express these to anyone because he was trapped alone in a side-room.  The way he shook my hand and said “you’re a good girl now, thank you” before I left clutching my sharps bin said it all, and made that day a little less rubbish.

Other nice things about working as a junior doctor:  being part of a real team.  At medical school, no matter how amazing the firm is, you’re never 100% part of the team, as there’s always going to be a tutorial/uni lectures to drag you away, as well as the relatively short duration of firms.  Once at work, even if FY1s are very much the most junior members, it’s nice to be part of something bigger.  Partly for the satisfaction of having achieved something by the end of the week, and partly for the relationships between different members of the team, particularly between FY1s on the same job.  Slowly everyone becomes friends, and that makes a huge difference to how boring or how entertaining a difficult day becomes.  You learn to work with all kinds of people, and those communication skills courses at medical school make sense (or what you remember of them anyway).

This is starting to remind me of medical school interviews, when one lists the reasons “why study medicine”.  The statement “don’t do it for the money” is very true, as you would get paid a hell of a lot more to be a banker/work in management.  However the rather cliché answer “to help people” has more to it than we give it credit for even for the little houseplant, as long as we realise that helping people can mean small things like adequate pain relief rather than life-saving surgery.

I have no intention of sugar coating FY1 year, or hospital medicine as a whole.  There have been plenty of tears over the last six months, days when an off sick FY1 or two means I get to carry three people’s workload, entire shifts without lunchbreaks, weeks where I struggle to find time to wash my hair properly, never mind have a life outside work.  It’s stressful, frustrating, there are angry patients, demanding consultants and unhelpful work colleagues.  But I think I’m in too deep to dig myself out now to be honest.  And no matter what anyone says, it’s never boring, and no two days are ever quite the same in hospital medicine.  .

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