Baptism by fire

It was overnight in the emergency department, my first shift as an intern. Twelve hours to go. Just don’t kill anyone. Twelve hours to go. This was all I could think of as I walked fearfully towards the ‘Eye Room’ with my patient following me. I had called out his name in a high pitched squeak, and when he greeted me with ‘Hi doc’, I looked around before it dawned on me that he meant me. 

Mental note 1: You are a doctor, no longer a mediocre medical student. You are a doctor.

As I walked, I glanced down at what the triage nurse had written. ‘Welder. Bilateral flash burn.’ I was relieved that the tears streaming down his cheeks were not due to disappointment at having been allocated me as a doctor. We reached the eye room and I groped for the light switch. Suddenly a siren began, lights flashed and I heard the thunder of footsteps racing towards me, and voices calling to each other. ‘It’s an arrest…the Eye Room…get the crash trolley.’

Mental note 2: Learn the difference between the light switch and the arrest button. 

My patient explained that he was 24 years old, married, and worked full-time as a welder. I began to take a history. Had he been well as a child? Was he fully immunised? Had he travelled overseas recently? Did he ever get short of breath? Did he have any trouble with urinating? Did he smoke, or drink or use recreational drugs? I drew a family tree noting that his maternal grandmother had had a hysterectomy. There was no family history of flash burn. Tears continued to stream down his face as I moved on with the general physical exam. It was unremarkable; he was normotensive with no postural drop, no evidence of goitre, chest clear, Babinski down going bilaterally. I glanced at my watch and realised an hour had passed. 

Mental note 3: Time is of the essence in the emergency department. I decided to skip the PR examination. 

A cold sweat came over me as I thought of a conversation I had had with a fellow intern during orientation the week before.

She had said: ‘Well, since neither of us can use the slit lamp, perhaps we should practise on one another now?’ 

I had said: ‘What are the chances we’re going to need it on our first day? Let’s check out the cafe.’

Mental note 4: Pay more attention to diligent coworkers. The latte had been a disappointment anyway.

My patient helped me grope around for the power switch on the slit lamp as I explained that I was used to a different model. I examined his magnified freckles and streaming tears for some time until I stumbled upon the controls. The patient whimpered as I bumped his nose. 

Mental note 5: Do not zoom in with such speed. 

At this point a registrar arrived and expressed amazement that I was still with my first patient. She processed the patient efficiently and asked me to finish up the last few things. Feeling exhausted and relieved, I escorted the patient out. Later in the tea room I overheard two nurses rocking with laughter at the incompetence of the new interns. They couldn’t believe what they had seen. 

Mental note 6: There are eye pads available; do not send patients out adorned with folded up menstrual pads.  MT