Dr Ailsa Mitford remembers her first night and why she was couldn’t reach her chocolate stash.

Starting F2 was just as daunting as the first day of F1. In my quest to develop professional skills I selected an emergency medicine rotation. Entering a choice on a form and actually living up to the implications of that choice are very different.

The reality of the added responsibility of making decisions on patient discharge suddenly seemed a big step. What if the anxious lad with a simple bruise had some rare clotting disorder? What if the drunken student with a hangover had gastroenteritis or appendicitis? What if the elderly patient with constipation had bowel cancer? What if...? I had a lot to learn and quickly.

My first day was actually a night, so my initial thought was to stock up on edible supplies to get me through. Comforted by the stash of food (ie, chocolate) in my locker, I was surprised that it remained untouched eight hours later. The shift went so quickly I didn’t have time to think about eating, let alone eat.

The night was a constant flow of patients with abdo and chest pain, and the occasional elderly patient with a UTI. I was secretly enjoying the work and learning from every patient I saw. It was nice to be able to discuss cases and trade stories with my colleagues for reassurance.

The usual inebriated patients made their appearance. My initial empathy at their sorry state was hard to maintain when they vomited, irritating the hard working nurses whom I was attempting to bond with (for all the right professional reasons, including the provision of cups of tea). One drunken guy who had been jumped by a gang of youths required a particularly lengthy examination as he had multiple injuries. I soon discovered he had the worst smelling feet I had ever encountered. The nurses had to be particularly stoical, as I was unable to put his shoes back on unassisted and yet again needed their assistance for an unpleasant task.

Working in a busy city centre hospital means that it may be a little too convenient for people to be “just passing by” after a night out. One lucky customer with a black eye managed literally to catch an ambulance that was “waiting at the top of the road” after being left by his friends. Don’t get me started on the use of ambulances as taxis.

There were inevitably some heart-breaking cases. First of all was a lovely octogenarian who had fallen over and now had a spectacular gash across his forehead. Having a weak stomach and being generally rubbish around blood and gore, meant I had ruled out surgery pretty early on in medical school. Consequently nothing quite prepared me for suturing the deep gaping wound extending over his eyebrow. It moved and bled profusely every time he blinked. I have never felt so pathetic as I did when he asked me if I was ok because I looked very pale.

Another sad case was a very elderly lady who had been left in the emergency department by her care home. She was unable to communicate, but wanted to hold my hand. All we had to go on was that she had been off her food for a couple of days.  I decided to face the wrath of her carers by waking them up at 4am. They claimed to know nothing more, and almost forgot to mention the phlegm she had been bringing up. I went into detective mode and she was eventually treated for severe community acquired pneumonia. I was able to put into practice our “surviving sepsis” teaching from the induction the day before. It’s great when training kicks in like that.

I was taken aback by an agitated gentleman who came in on his own, concerned that little green aliens were crawling all over him attempting to abduct him. Unsure whether to reassure him that they did not exist, or to enquire about what they were saying, I felt it would be easier to take a history if I did the latter. Anyone listening through the curtain must have thought I needed help too.

As dawn came and went and the city outside our cocoon began to wake, we were counting down to the end of the shift and beginning to relax. It was then that the dreaded phone rang, and rang and rang. We had five stand-by calls in two hours. I treated a large patient with reduced consciousness who may have had a stroke. I attempted to elicit a history from both the patient, who would not co-operate, and his wife. However, the subsequent battle for venous access and bloods indirectly meant that I was able to see the patient moving all four limbs, which he had previously refused to do. Result! I was secretly quite pleased with myself that I was learning to adapt standard techniques to real-life situations.

We somehow managed to deal with the onslaught of patients and clear the decks, just in time for the day team to arrive and utter “quiet night then?”

Ailsa Mitford was an F2 at the Royal Liverpool and Broadgreen Hospital.

Highs

• working in a very close team and making great friends
• learning from an exceptional variety of cases
• growing confidence
• the immediacy of saving lives in an emergency situation

Lows

• working unsociable hours
• politics of the four-hour rule
• patients wanting a second opinion after ignoring their GP’s advice
• drunk and abusive patients and relatives