“So you’re working on HPB? My apologies…” This line seems to be a running theme of my induction week as I enter my F1 year. Everyone I speak to, from consultants to reception staff (and memorably, one taxi driver), knows the hepato-billary/pancreatic wards as an incredibly tough place to work – the sort of place a junior doctor shivers to hear the name of, where the days are long and the patients invariably very sick. This was to be my first job, fresh from medical school, just a few days out from my graduation and a few months after my finals. By a twist of luck, however (and strange that I should be saying such a thing), my first days would be spent in ESAU – the emergency surgical admissions unit.
So here I am, a brand new set of scrubs (they say doctor on them – a terrifying responsibility, I desperately want to stick a post-it over it and hope that people don’t notice me), a bleep thrust into my hand, my old stethoscope around my neck and off I go – ready(ish) to face the wards.
Perhaps I should introduce myself. Hello my name is Ash. I’m a 2016 HYMS graduate and I’ve moved to Liverpool, a city I don’t know, to start my Foundation Year 1 (FY1) at the Royal Liverpool University Hospital. Now the first thing you notice as you enter the Royal, and the first thing I noticed as I walked in on my very first day, is the clock. A brand new Royal is being built behind the old hospital and as I enter, the clock is counting down from 350 days. I am among the last set of brand new doctors to make this entrance and all of my FY1 year will be measured and counted down as I go. I decided that I quite like that, and began to wonder how many days the clock would tick off before I would feel confident about making this walk.
ESAU itself proved to be exactly the trial by fire I had been expecting. The pace was frenetic, but the staff were entirely lovely and I was struck by a very palpable sensation that everyone knew the FY1 doctors that morning would not be the experienced doctors that had been on the ward only the night before.
My first patient was a lady with cellulitis over a surgical incision site. I’ve wondered for a very long time how I’d feel as I approached my very first patient. I’d assumed I’d be filled with panic as I realised the responsibility of what I was taking on, but with this lady I felt none of it. Maybe it was how at ease she put me, how experienced she was around doctors. She told me about the book she was reading and how long and often she had been in this hospital. She made me feel like the doctor I had qualified to be.
The rest of my day would not be quite so forgiving. I spent far too long trying to work out how on earth I was to prescribe unfractionated heparin and then did much the same with intravenous insulin not fifteen minutes later. These are not simple tasks. I suspect I will not have a day for the rest of my career filled with simple tasks, but I didn’t mind, I didn’t panic. I’m sure I made mistakes, but people around me seemed to have more faith in me than I did, and when I got to clerking patients and got to introduce myself as “one of the doctors” I felt a strange sensation that I had waited a long time to do this and maybe I really was ready for it after all.
As the clock wound down to the end of the day the lady I had seen at the start was being wheeled out to the wards. Without hesitating, I blurted out that she had been my first ever patient. I instantly regretted the decision and desperately hoped she wouldn’t sense the terror every FY1 in the country was feeling on that day. She smiled, said she knew what day it was, and that she had liked me. I could not have been happier as I left the hospital.
There it is, I finished my first day! It was survivable, memorable, even enjoyable. As I write I am more than a week in, and continuing to survive. I’ve been through an on call, my first medical emergency, and my first death certificate. I look forward to telling you more about it as I navigate life as a brand new doctor. FY1 doesn’t seem quite so terrifying as I always thought it would be.
Ashley Holt is a brand new FY1 doctor working at the Royal Liverpool Hospital. He graduated from HYMS this year.