Friday, 6 August 2010

Who remembers their first emergency call?

I think experience hardens us all. Nowadays, when I hear the emergency pager go off I stay pretty calm, and I know what has to be done. I know I have the skills to offer a high standard of care, and I know that I have a world class ICU in the same building to help out.

But this sure as hell wasn't the case when I was an intern. On the nightshift, having only been a doctor for 5 days, the emergency beeper went off. This doesn't necessarily mean a cardiac arrest. It can just mean that a patient is heading for one if something isn't done quickly. Much of a muchness for a scared junior doctor, though.

I heard the odd noise, and realised it was the red bleeper attached to my belt. The one I'd hoped might never go off. "222 ward 12" the screen read. When you get the location of an emergency as an intern, your first thought is "I hope I'm far enough away from this so that someone else gets there before me".

I was on ward 11 at the time. Next door. Dammit.

Anyway, no time to dilly dally. I strode into ward 11, trying my best to look confident as I walked over to the group of nurses surrounding a very very pale looking man in his 70s, who was desperately struggling for breath.

medical school just hadn't prepared me for this. What the hell was wrong with this guy?? I knew a whole load of causes of breathlessness. But he was going downhill quickly, and I didn't have time to do a "medical school" history and examination. You know the ones I'm talking about...the examinations where you listen for renal artery bruits and ask about hobbies in the social history.

First thing I decided to do was speak to him, and try to reassure him. But I couldn't. At least I couldn't get his name right. I kept mispronouncing his relatively simple name. I just got tongue tied. Needless to say, this inspired a world of confidence in me.

Why aren't the rest of the arrest team here yet?

I started some nebulisers, and asked the nurse to give him some intravenous steroids. Of course, his cannula wasn't working any more, so I had to put one in. My hands were shaking. My success with inserting drips was patchy at best. But I'd never been under this kind of pressure. I couldn't see a vein anywhere. So, I just rammed the needle into the part of his antecubital fossa where I knew there should be one! Thank god it worked.

But he was still struggling. And I wasn't really sure what to do next.

SURELY the team must be on the way. This guy needs aminophylline and ICU and central lines!!!! And we should probably intubate too!!!!

With that, my Registrar and Senior House Officer (SHO) burst in. Looking at their sweaty, shaking, stammering intern they must have thought something awful was going on. But as I recounted the story, and the SHO examined the patient the registrar said "Ah, he'll be fine. Just keep going with the nebulisers, we'll get a portable chest x-ray, do a blood gas and ring me with the results. That was a nice easy one for your first emergency. Well done, kiddo".

A nice easy one!?! Surely it doesn't get worse than this??

Then the ICU registrar turned up, to see if we needed him. My Registrar said "Nah, it's nothing major. No need for you to be involved".

So, there I was, living an event that will always stay with me. Yet it was "Nothing major" and "a nice easy one" all at once.

To be fair, the registrar was right. In terms of what I deal with in neonatal ICU or in paeds ED, it's not much. But it was one of the scariest experiences of my career.

So, was it just me? Or did anyone else loose half their circulating volume in sweat at their first emergency, and feign a stroke with their inability to speak?

Dr Thunder


  1. At least the patient didn't die on you! LOL

  2. First emergency as a student nurse had to be a guy pulling out his tracheostomy tube, almost arresting on me and them repeatedly punching me in the face as I held the dilators and administed oxygen while shouting for help. I got a black eye but he lived. Fun times!!

  3. yes, as a newly qualified nurse I called out a crash team to what they tactfully termed a vasovagal attack - leaving me to explain to the rest of the staff that the patient had fainted. And that I had panicked.

    Newly qualified and agency - is there a worse combination?

    Other incidents: never worked in this particular hospital, all of the staff were agency and new to the place: one patient had anaphylactic shock; another passed out rigid post-op; the doctor (intern?) asked me what the usual analgesia was (I'd no idea) - that shift was my last. I'd so many sleepless nights afterwards as we'd had to run around trying to find out what number to ring for these emergencies.