On Call : Dr. Daisy Dashwood writes........

Day 11 in the Royal Scottish Hospital. I have not had a day off yet. However, I have as yet managed to escape being evicted and the closest I have come to this is a showdown with pharmacy yesterday when we discharged 14 patients after 3pm. Everyone's really friendly here - which is lucky for 4 PRHOs thrown in at the deep end. We knew that we would be getting a crash course on how to infiltrate the crash team. After we'd gone through the various scenarios and fought over who got to play the hysterical relatives, it was home time. Well, all except for one unlucky bastard. No prizes for guessing who was on, with no SHO. My first clerking-in as a doctor was an elderly lady who was 'off her legs'.

"Be a UTI, be a UTI," I prayed fervently, as my legs carried me towards the door.
"Hello Mrs. X," I said cheerfully, as I breezed through the curtain.

She ignored me. Thinking that the old dear might be a little deaf, I persevered.. this time more loudly

"Mrs. X, I'm Dr. Dashwood and I've come to see you." (Pause). "Can you tell me what the matter is?" (Pause). "Just take your time." (No response. Perhaps she was dead? In a sudden panic, I grabbed her wrist. Phew, the pulse was still there).

"Okay, I'm just going to have a look in your notes."

"Mmmmmm." A response!

"What is it Mrs. X?"

"Mmmmmm." This time more urgently.

I flick through the notes. Trust me to get a lady with an expressive dysphasia in my first night.

"I see you've had a stroke, Mrs. X. Perhaps you can write down the answers to my questions...what's that....ah, you've lost the use of your arm as well. Perhaps the left arm? No? Ah, well, we'll just try to muddle through."

That was my baptism of fire, my first night on as a Junior Doctor. Mrs. X went over to the Geriatric team and now I have my own eclectic assortment of patients, including Mrs. Y who has her own unique expressive dysphasia, and refers to both pills and toilets as pins.

Thankfully, the arrest bleep didn't go off on that first unsettling night. However, one week down the line and it was eight pm on a Saturday night. Gordon my SHO and I were just coming to the end of an exhausting day, wading through all the alcoholics who had fallen off the wagon on the Friday night. I was hanging out in the A and E Doctor's Room, on the phone to Gordon, seeking advice on the best dose of chlordiazepoxide to administer to a man cringing from the spiders on the roof of treatent room 3 when it happened.

"Cardiac arrest, Resus 1, A and E."

I love the way the bleeps talk to you when it's an arrest. They test them periodically throughout the week, and I'm not joking, the risk of incontinence is hardly limited to the unfortunate arresting individual when that thing crackles into life.

"I'm in A and E, I'll meet you there," I said nervously, before slamming the phone down and barging through a crowd of relatives. The adrenaline was pumping as I raced through the curtains. The ECG machine was standing by the patient, an elderly man who was groaning upside down on a bed. ECG? I decided to go for the IV access route and whapped in a green venflon, by which time Gordon has arrived to interpret the rhythm. That was my best cardiac arrest as we pulled the guy back from the brink of death. I'm sure in time I shall forget the moment when I was in amongst it, ready to do heartstart in front of the shocked relatives, after bellowing for my SHO across ITU. The nurses assure me that uinless you've seen the tracing a dis-atached ECH creates, it's all too easy to confuse it with asystole.

We've had a few interestiong characters through our doors. Half of them are on chlordiazepoxide and I'm sure no PRHO is as skilled as I in the art of sedation. It's got to the point where Radiology won't scan my patients unless we can assure them that they're suitably compliant and loaded up with a killer dose of midazolam.

Gordon was telling me about this one disturbing night he had on call, in Glasgow. He had a patient who had had a sudden re-emergence of his schizophrenia, and in an unprecedented state of mania, had legged it out the window of his fifth floor flat, subsequently dislocating both his hips. The gentleman was hospitalised, and kept under control with a generous whack of diazepam. Sensing through the haze of drugs that something was not quite right, the man in question would often refuse his medication and the nurses would bargain with him in an effort to coerce him into swallowing the pills. However, the night when two new nurses came on the shift was one which Gordon would never forget. In a trembling voice, full of emotion, he recounted his terrible tale to 4 wide-eyed House Officers.

It was a dark and stormy night when he was bleeped by the Nurses to come and have a look at Mr. Z, who was acting a bit strangely. Apparently, he had missed his last 2 doses of (2 hourly) diazepam and was getting a touch out of control. "Nooooooo!" though Gordon, as he raced helplessly up the stairs. Mr. Z was in a side room and was audible from the other side of the ward.

"You've possessed the doctor, the doctor's possessed!" muttered the patient, his eyes roving wildly.

"Here we go again," thought Gordon.

"You're the Devil, the Devil's taken over the Doctor, he's the Devil."

"Why me?" moaned Gordon.

Unfortunately, it was impossible to get near him to give him an IM or IV bolus, but luckily, Mr. Z was in traction. Or so he thought. One broken traction device later, Gordon was flattened against the wall, as the patient began to rise, like something out of some awful horror movie, and lumber towards him. Hot on the trail of the Nurses, he legged it out the door, and spent the following hour outside the room, looking through the window and shouting 'Put the pole down. Put the pole down.' whilst the nurses held the door shut. Gordon had never been so glad to see the police.

You do feel good when you find something, though. Like a high potassium which can be brought down. Or simultaneously wiping out the stones, bones, groans and psychic moans of hypercalcaemia with adequate hydration. Equally, when you get it wrong, it totally puts you on a downer. Like the guy who came in with a massive nurofen and zopiclone overdose, also on high-dose painkillers. I sent him home on paracetamol as I didn't want him within striking distance of tramadol, and he came in the next day with the same problem, only it was paracetamol this time. My reasoning was that he could easily walk into Boots and purchase paracetamol, but that it would be cruel to leave him in pain.

The perks of the job really outweigh the low points. When an old man with COPD wheezed to his grand-daughters that I was 'the nice one', I was skipping from ward to ward all day. Low points include having to examine my bronchiectasis man's muco-purulent sputum thrice daily (there are several cupfuls -and it works better than any diet I've tried!) and trying to cannulate my out-of-control diabetic with a serious needle phobia. Or examining people's testicles. Most days, I leave the hosital, covered in various patches of vomit, sputum, blood and grass. Whilst doing a particularly strenuous PR on a man whose BMI must have been somewhere around the higher forties, I even knelt in a pool of vomit.

You learn to get on well with your staff. It's true, the nurses are your best friend. It's equally important not to offend anyone, well, not a week into your House Job, anyway. I'd made a(nother) referral to Psychiatry and was expecting the liaison nurse to pitch up at the Ward. I came out and saw a rather unkept-looking man standing outside the patient's room, perusing his notes.

"You must be the psychiatric nurse," I smiled, taking his hand. "Hi there, I'm Daisy, one of the Doctors."

The man looked me up and down before saying tightly "And I am the Consultant Psychiatrist."

"Of course you are," I muttered, scarlet-faced, before backing away into the Doctors' Room, in due reverence.

Much of the week has been spent in the hospital, with the odd night where we all stumble back to the residence and collapse in front of the TV to escape the hospital and watch ER. However, the Drug Reps have started making tentative visits to the Doctor's Room, and we're primed for a night out. Drumnadrochit, here we come!

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