On call: panic mode activated

Profoundly dreading my first on-call, that also happened to be my first-ever shift as a doctor. I couldn’t help but think, what a way to start! It felt as though all my medical knowledge had evaporated into the air and dispersed itself back into my brain in a wild jumble. Impending responsibility induced vertigo and amnesia, which overrode the recollection of the hospital tour, and I found myself constantly lost in the maze of big rooms and endless corridors. Having so much information thrown at you, like rotten vegetables at a bad actor, made it nearly impossible to retain most of it. Yet, if generations of doctors have walked this exact path before me, I know it’s possible for me too. 

The bleep – a device that seems designed solely to disrupt every moment of peace – was handed to me, and I quickly learned its power. Starting off with unexpected kindness, it allowed me to take a seat, brew the perfect cup of tea, and then, just as it reaches the optimum temperature, where you can take a sip without wincing from the heat, the echoes of the siren wail across the doctor’s mess and every hair on your skin stands up straight. You answer the call and are swiftly summoned away. I answer with such urgency that the nurses can barely believe it, I am there in mere seconds (clearly, experience, which I was lacking, lends a greater understanding of what calls require such timely arrival). Despite my body living only seconds, my brain has lived hours, pontificating every possibility, making a catastrophe of every scenario. My feet can barely keep up with my racing thoughts, and by the time I arrived, breathless and slightly disoriented, I was starkly reminded of the hospital’s vast size—and my own need for better cardio! 

“We have been expecting you, doctor,” said a nurse, his words stirring my anxiety. I wished I could remain unseen, like the crumbs hidden deep within a sofa’s recesses, but there was no escaping the jobs. Everything felt foreign; all my knowledge seemed purely theoretical, and I struggled to translate it into practice. 

Yet, whenever I faltered, the nurses had my back! Chlordiazepoxide reducing regimen? They handed me the proforma. Ondansetron dose? They wrote it down for me. Catheter size? “Did you even go to medical school?” one nurse asked, jokingly (at least, I hope it was a joke…). The depth of support I received from the entire team kept me afloat, guiding me through each task. 

As the 10 hours of odd jobs, discharges, and medical reviews began to wind down, I was hit with a barrage of last-minute tasks. When paper becomes practice, it’s easy to get lost in the details. Still, I soon realised that the hundreds of pages of medical school notes were only a snapshot of possibilities in a field where every patient needs something different from you. 

Somewhere in the night, I found my rhythm. My workload became more streamlined, my efficiency improved, and I no longer second-guessed every decision. I prescribed without hesitation, trusted myself not to check the same blood result three times, and even remembered a patient’s name on the first try! 

The on call shift is daunting. You feel alone, in an ocean of sickness where you are expected to perform to the standard set by the previous cohort (who are now just aging into FY2s). But, one thing to remember is, the pressure is off. Everything can wait. Every decision you need to make, there is time to make it. No one is expecting you to resuscitate a dying patient on the first day (nor would anyone ask you to). Nurses will ask you exactly what they need from you, knowing your level of experience, and the main challenge is differentiating between the tasks that are a quick fix, and those tasks that require a level of experience greater than you can offer. 

But, be prepared for post on-call clarity. The sudden realisation that you forgot to send a blood culture, that you forgot to document something, that you forgot to go back and tell a patient their blood results when you said that you would. You nitpick your own day in the office, and critique every decision you made, but, worse of all, you think about how your colleagues, especially consultants, might respond to your plans, how they might question your qualification, and think you are a bad doctor, for starting nitrofurantoin and not trimethoprim. While you’re in bed spiraling, your colleagues carry on with your work like any other day, and to be quite frank, your name barely comes up (but if it does, most often it’s because you have done something very, very right!)

Dr Peter Crabtree

F1, East of England Foundation School

All previous HOFP articles can be found on on our HOFP webpage