The night shift

A tale of sleepless nights, bloods and cannulas

When we think of a doctor we think of figures like Dr House MD, ER emergency doctors or Gray’s Anatomy’s modelish like doctors + all the drama. The reality of being a junior doctor hadn’t struck me until my first duty (which is basically a 32hr on call shift) which we as juniors have to do once per week. My ego told me ” hey you studied for 5 years now you are ready!” …honestly i couldn’t be so wrong!

It started at 3pm. after a busy morning discharging patients and writing up discharge letters in cardiology, and dealing with all the extra BS some consultants and seniors come up with, the dreaded duty started.

At the time I was in the doctor’s quarters room resting and trying to get some sleep before all hell breaks loose, like a bad first person shooter game of the 90’s…..My phone rang. I didn’t hear it. I was asleep. It rang again. And then again. I wearily checked my pagerphone and I heard correctly, It was the dreaded MAU (medical admissions wards) paging. So i taught to myself Oh crap this isn’t going to be good!

Ward Nurse1: Hi doctor, we have some bloods to chase, cannulas and a patient’s oxygen is desaturating….can you come see him?. Right, that call alone wasn’t so bad or so i thought until i got to the ward to see a board with all the jobs to do. Well, i did do my training on cannulas and taking bloods is just easy so this shouldn’t take time to do. How wrong i was!

as i walked into the ward and i approached the deck i took a good look at the board and noted down the jobs i had to do on a piece of paper. So, bed 25, 23 need cannulas, a trop for bed 19 and aPTT for bed 21….ect… after noting them down i went over to see the most important task of this call, ….the guy who was desaturating.

Although I had read about hypoxia in medical school and had learnt the causes and treatments when you are faced with a real patient and when you realize they don’t respond as easy as according to the text books…a feeling of anxiety sets in. In the rush of the moment and as the ward is quite a busy place i had to think fast on my feet and get his oxygen levels up. So i treated him with oxygen, monitored his parameters and propped him up, asking the nurse on duty to monitor him and reassess and call if something happens.

next was the dreaded cannulas. Now this was a hard one. unlike healthy young patients with good veins most of the patients at the medical admissions ward are very elderly old frail people who have terrible veins that are ravaged by high glucose and diabetes or have other conditions causing oedema, that makes it impossible to view a vein unless you have some sort of super human vision. So…i got everything prepped up and tried to go for it. After 3 attempts i gave up, felt ashamed and called my senior BST medicine, hopefully he would swoop down and come save the day. indeed after a few attempts, the experienced senior doctor just localized the vein with their super human abilities and cannulated it like it was no problem, leaving me wonder ….how the heck did this guy manage?

As i was ready to take bloods and donning my PPEs …offf goes the pager again …BEEEEEP! BEEEP!!…so I had to go out of the room, remove my gloves and open up my PPEs to reach for the pager and answer the call. It was another ward calling, they needed me to chase some bloods, dose warfarin and prescribe a sedative agent to a highly agitated patient. At this point the list of jobs was increasing and it was only 5.30pm in the afternoon. Not having done much after struggling to get 1 cannula into a patient i went on swiftly to take bloods from a chest pain patient that needed urgent Troponins.

Finishing up the last jobs,I rushed up the hospital corridors and went to my new ward M5. Where yet again I found a board covered in jobs for me to do. I first started of by going to visit this highly agitated patient, who had been trying to get out of bed and had been punching the nurses that tried to hold him down. I prescribed some sedative agent and proceeded to continue on the next jobs.

8.30pm A shift begins….This is the actual on call shift, on this shift doctors are called from all hospital wards between 8.30pm -11.30pm, and being a Monday the calls kept coming averaging a minimum of 43 pages. The current Covid situation wasn’t of help, as most doctor’s had been quarantined the current team of on call doctors was down to 6people covering all the hospital’s on calls.

And at 8.30pm my pager started again Bleeep! bleeeeep! bleeeep!

My next call was to go see a patient who had not passed urine for the past 4hours and was in pain. So, great another acute and this was just my first duty on call.

I rushed once more the the same ward as before, and wondered to my self why hadn’t the nurses notified me while i was actually on the ward its self. Having gone down to the quarters to get a coffee and a well deserved break. I rush back up to see the patient. Trying to get a history from this patient was tough. he was confused not cooperative and i couldn’t determine well enough if we actually needed a catheter in place. Not knowing what to do, i decided to call my senior and ask for advice. After a wile we decided to call the nurse and place a catheter in the patient. It actually worked ! and i felt relieved that i managed to get the patient stable.

of course the pager was bleeping again, with more jobs from other wards. Most of which included really difficult cannulas and taking bloods. After a really crazy shift and not having even the time to eat or pee. The crazy shift A came to an end at 11.30pm. I headed back to my room and crashed on the bed hoping that i would not be paged so early and that i could get some sleep.

This first on call made me realize the importance of sleep, how much i actually took it for granted. next up was the morning on call that usually starts at 5.30am -7.30am before going on to my ward work and ward rounds which spans from 7.45am -2.30pm.

So.

I charged my pager, ate some peanuts (which was my only meal) drank some coffee….and slept.

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