Black Wednesday Cometh…

Next Wednesday, the first in August, is an important one for all doctors. It is ‘affectionately’ known as Black Wednesday, and marks the day, across the country, across the years, where all newly qualified doctors officially start their very first jobs as doctors. Not only that, but all doctors in training posts move jobs, often move hospitals, to continue onwards and upwards with their training, gaining new experiences and new responsibilities. It tends to be a little chaotic, with thousands of doctors across the country needing induction to new systems, software and most importantly, fire safety guidelines. The gaps on the ward tend to be covered by the more senior doctors or doctors like myself in non-training roles who are staying firmly put in their chosen hospitals. The sensible consultants book their summer holidays perfectly to return once some semblance of normality has returned to the hospital.

My own inaugural Black Wednesday was twelve years ago. Here is how fresh-faced I looked in the weeks leading up to this…

I have absolutely no photos from during my first year as a doctor. I think that says a lot! I can assure you I would have looked like I’d aged at least ten years.

When I started first year doctors were still called house officers. They are now F1s. I worked my house officer year in a huge tertiary hospital, full of professors and leading experts in their fields, with many consultants particular specialty being belittling house officers. It was a crazily intense year, the steepest learning curve of my life (excel for my first year of motherhood) and changed me forever. I had all the exams, all the theoretical knowledge and clinical practice that was expected of me before taking that house officer bleep, before running the patient list, but the realities of it still came as a huge shock to me. I was the doctor who would be on the ward at least half an hour before I was due, and leaving at least two hours after I was supposed to finish, and lunch breaks were an unexpected treat. I guarded my patient list with my life, I probably tended it more diligently than I have my children. As the house officer nobody knew my patients better than I did. I was there with them on the wards day in, day out. I knew their families, I listened to all their worries and celebrations, I tried to placate all their complaints. The ward nurses were essential to getting me through each day, often being the ones to actually show me what the hell I was meant to be doing.

I lived on M&S ready meals that year, I lost stones in weight, and was a size 12 for the only time in my adult life. I ran up and down more staircases than I can possibly remember, all in my kitten heels.

The most intense of all my jobs was vascular surgery. Our list was always huge, with far more patients than we could realistically be expected to ever manage. They were also incredibly sick, with failing hearts, kidneys, lungs, with flesh rotting from their bodies and blood vessels that were either closing off or bursting. They were also, as a general rule, the most stubborn, cantankerous patients I have ever met, (the consultants tended to have similar personalities) refusing to give up tueir beloved cigarettes regardless of how often they had to return to the operating theatre to have more and more pieces of their limbs cut off. In that job I routinely worked twelve hour days when I was expected to work eight, and was permanently exhausted.

It may come as no surprise to people who know me that this was my favourite job of all time. I loved my cantankerous patients. I loved looking after complex comorbidities and terrifying medical emergencies. It was a trial by fire and it forged the doctor I would become. Despite the long hours I would leave my bleep number with the registrar on call, to get me in to help out in theatre if any exciting emergencies came in. Usually house officers struggle to get to theatre, but late in the evenings and weekends I would come in my own time to assist. As a house officer my first surgical procedures were an above knee amputation and an embolectomy. Having done my best to avoid theatre as a medical student I had now truly fallen in love with surgery and had discovered the kind of doctor I wanted to be. Not the cerebral sort, sat in an office scratching my chin and postulating clever diagnoses, House-style, but instead getting stuck in, and handling emergencies.

During that job I experienced a lot of death. Unfortunately that comes alongside the very sick patients and the emergencies. It was particularly hard when these were patients I had come to know very well through all those hours on the wards. I had to come to terms with it pretty quickly. I don’t really know how that happens, how you get used to death, but it does. It has to.

I did initially go into surgical training, but life happens and it soon became clear that emergency medicine holds all the thrills and sick patients and practical skills I had loved, but also allowed me to clock off once my shift had finished, knowing that somebody else was able to look after the patients I had admitted, able to look after the new patients attending. It allowed me to do the medicine I love whilst staying vaguely sane, and not wake in the middle of the night with palpitations at all the work I had left unavoidably unfinished.

Twelve years on and that very first day stays with me. I remember how terrified and out of my depth I felt. I remember how a snappy, humiliating comment from my infamously mean registrar reduced me to tears on my very first ward round, and I try my hardest to be supportive to the junior doctors I now support. I often feel like I haven’t managed, when the conflicting and endless demands of my role lead me to be brusque and dismissive when asked for help. I try to remember how that feels.

Twelve years on and I am still learning. Still very much learning. In fact yesterday’s shift challenged me anew, reminded me how it feels when a request for help is dismissed or misunderstood, reminded me that I can’t be complacent, that I will always be learning, to the day I blissfully retire. And that’s ok. We’re in this together, and those new doctors starting next week will have more to teach me, and hopefully I’ll be able to teach them something too. Hopefully in years to come they won’t be writing about that mean doctor who made them cry about when they first started. Its a very rare thing for me to cry on the job these days, thankfully, but I’m also thankful that after shifts like yesterday’s I have not become so used to it now that I can’t still have a cry on my walk home.

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And here I am now, after the ravages of twelve years of medicine (and the two sleep thiefs I have for children!)

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