Life as an FY1 - Better Safe Than Sorry

Hello! I am a newly qualified FY1, and have been roped in to blog writing by the almostadoctor team… you can read the first of my exploits below!
I wrote this at the end of my second week as an FY1, but it’s taken me a couple of months to build up the courage to post it online.
Please also be aware that there is some strong language…
Nothing’s ever black and white…. and a lot of the time, the grey areas can make you feel like a complete idiot.
That’s what happened to me a couple of months ago…

I was walking down the main hospital corridor when I decided I needed to bleep somebody. So I quickly slipped onto the nearest ward to find a telephone. Oops.

Just as I lifted the receiver at the nurses’ station, out of the corner of my eye I saw a patient drop his drink and slump back into his chair. A couple of nurses ran over, and began shouting the patient’s name. No response. They beckoned me over. Shit!... …
 
My heart starts pounding. I don’t even know the poor guy’s name. He’s not one of my patients. Never seen him before.  I ask the nurse his name. She tells me.
 
Mr Weasley? Can you hear me Mr Weasley!?” Still no response.
 
Ok. Try to keep calm. ABCs.
A. Hmm A? A?! Airway. Phew yes. Airway. His mouth’s open. I take a quick look inside. Hmm I suppose his airways patent. Although he did just throw his drink everywhere. But he’s not coughing. So I doubt he’s got some particularly viscous Sunny D lodged in his trachea. In fact he’s not really doing anything since he groaned and slopped that OJ all over the place.
 
B. Bugger. I’ve only ever seen one patient die before my eyes, but it did look an awful lot like what’s happening right now.
 
Ok. B – Breathing. Hmm doesn’t seem to be much respiratory effort. His chest isn’t moving. I can’t feel any breath on my cheek.
 
Bollocks. I left my stethoscope back at the nurses’ station. No time for that now. ‘Can we get him on 15L of oxygen through a non-rebreathing mask please?’ Oh who said that? Oh it was me! Really? Where did that come from?!
 
C? Ah, circulation. Let’s check the pulse. Oh dear. Can’t feel too much down at the end of his arm. Ooh he’s got a nice cannula in though.
Let’s try the neck. Nope not too much going on there either. Oh fuck. This is all happening rather quickly isn’t it?!
 
‘Nurse, can you put out the crash call please.’ One of the rather panicked looking ladies busying themselves around me rushes off to the phone.
 
Mr Weasley is still sat in his chair. ‘Can we get him onto the bed?’
 
‘I think he’d be better on the floor, doctor.’ Oh thank God. The doctors here. I look around. I don’t see any doctors. Oh. She’s talking to me. I’m the doctor. ‘Erm, yes of course, let’s get him on the floor’. Four of us go to manoeuvre the gentleman to the floor. I grab his legs. Oh dear look what I’ve done now. I’ve pulled his leg off. Except, thank goodness, they’re not his real legs. They’re plastic. If I wasn’t having an attack of ‘what the fuck do I do?! Shit, bollocks, crap, bugger’ then it would probably be quite funny. As it is, I leave his prosthetic limb dangling by his trouser leg, and continue to help get him to the floor.
 
I kneel down next to him. Oh dear. The floors all wet. And yellow. I take a quick look down at my trousers. Ah phew, at least I’m not responsible. Perhaps old Ronald here has lost his bladder control in all the kerfuffle. Anyway, can’t worry about that now. His eyes have rolled up. He looks a bit blue. Oh this doesn’t look good. This is what dead people look like.
 
Right, here goes. Am I really going to do this?! Well I suppose I’d better do, if I’m going to do my job properly and whatnot. I pull up his t-shirt and begin chest compressions.
 
1… *CRACK###@#*!
2… **cRUnCh$$&*!
3… #CrEAK!**
This is definitly not what resusi-Anne feels like. Oh for God’s sake this poor man is not dying with any dignity, is he? At this rate he’ll have flail chest by the time I reach 10 compressions. Anyway, better keep going. I manage a full 30 compressions, complete with 30 rib-destroying sound effects. Old Ronald here still isn’t doing very much.
 
Oh, wait a minute. He’s gurgling. Is that agonal breathing? Not sure. ‘Where’s the bag and mask?’ I ask. Well actually I think I shouted. My normally cool calm collected self was left at the nurses’ station about 74 seconds ago.
 
Oh no time for that, he’s about to vomit. ‘Can you grab me that guedel please?’
 
A helpful nurse thrusts a green plastic tube into his mouth. I quickly roll him. In the direction away from me (obviously). Ah yes he’s vomiting. That’s a good sign. And he’s doing it all over somebody else. And not me. Which is a bonus.
 
Hmm what’s that terrible smell?! Ah he’s suffering from faecal incontinence too, for good measure. He starts mumbling. He’s gone red in the face. Oh this doesn’t look like the kind of thing dying people do. He seems to be getting a very lot better, extremely quickly. Wow I must be a terribly good doctor!
 
The crash team arrives. “Goodness me his leg looks in a terrible state!” the Registrar exclaims, seeing limbs posing at impossible angles. Oh no don’t worry. Its plastic. “Ah OK. What’s happened here?” I give the crash team a quick 10 second run down. They all gather round and quickly take over care. Mr Weasley’s talking again now. I ask if they need me anymore, and then quietly slip away.
 
There’s a bit of audience gathered at the door. A few passing doctors, some medical students and a few others. In fact, everyone who works in the vicinity seems to be coming to have a look at what’s going on.
 
I get a sympathetic hug from another FY1. I’m all sweaty and flustered. One of my friends helpfully adds that he’s never seen me ‘this shitted up before’. Thanks.
 
What on earth just happened?! Oh dear. I think I just did traumatic chest compressions on a man having a pleasant nap. I hear someone say he’s epileptic. Oh thanks. That information is really useful now I’ve just finished destroying his rib cage. Ah stop being so hard on yourself doctor! Perhaps you just performed the most effective CPR ever recorded!
 
The ECG has just printed out. It’s completely normal. Mr Weasley is back in bed now. Sat up. Perfectly alert. He says his chest is a bit sore. Surprise. Turns out, he’s also got some kind of vasculitis. Which makes it rather difficult to feel his pulses. The Med Reg is having trouble despite his current consciousness.
 
The crash team come to write up some notes. The Reg says she thinks he had a ‘vaso-vagal’. Ah right. Yes. That makes me feel so much better. That’s just one step up from nap. So, he fainted. I called the crash team, and caused multiple fractures on a man who got a bit light headed. Great. Did I remember to pay my MPS subscription this year?!
 
After thoroughly documenting the events in the notes (of course), I went for a cup of tea and a sit down. My fellow F1s are all very supportive. And also a bit giggly. Apparently this whole scenario is hilarious. But they do agree that they would have done the same. The matron also congratulates me on what a spiffing job. She says she’s never seen anyone look like that when they’ve fainted before. And, whatever the crash team says, ‘he definitely wasn’t breathing when we arrived’ she assures me. Hmm but I still can’t help feeling a little over zealous.
 
So, what did I learn from all this?!
Well. It was terrifying! But actually, I did what I should have done. Maybe I could have listened to the chest with my stethoscope, maybe I could have felt a bit better for a pulse. But that’s not in the ALS protocol, and at the moment I started CPR I genuinely thought he was dead. You can’t go beating yourself up about it.
 

And next time, maybe I’ll check more carefully for a pulse before I start such highly effective chest compressions…

 

**UPDATE - May 2nd 2012 **
There are a few more details to this story that have emerged since it was originally written.

Firsty, Ronald's Chest X-Ray.
On the day in question there was much anticipation amongst the junior doctors of the hospital (news spreads quickly) to view the chest x-ray of Ronald to see if there was any trauma. In fact, I do beleive there was even a sweepstake as to the total number of broken ribs. Of the 8 ribs which were completely visible on the poor quality film, all were broken. Excellent.

Also, news of the story spread quickly across the country. And, as always, certain details were mis-recalled, exaggerated, and lost as the story became a myth. My personal favourite:
"Oh you work at XXXXX hospital dont you? Didn't a junior doctor break someone's legs doing CPR?!'

Not for from the truth I suppose.

The End.
 

[image from wikipedia]