FY1 Diary Entries

Entry 1

I sat alone in the doctor’s office staring wryly at the ugly, part- broken bleep I had placed on the other side of the room as I attempted to eat the cold, dry sandwich I had thrown together before I had rushed out of the house to try and catch the last metro to work earlier that evening. It was 2am and I didn’t even know which meal I was trying to eat. This was my 4th night shift and I could physically feel the conflict between the caffeine I had made myself drink and my body’s plea for sleep intensifying. Like clockwork, just as I was about to take my first bite, the grating shriek of the bleep cut through the air. I put my food down with a weary sigh. I glanced at the number and felt a sudden pit in my stomach as I immediately recognised that it was the acute surgical ward. I called them back silently hoping that the bleep had been a mistake or even that it would be another soft request to prescribe PRN Paracaetamol.  

‘Hi it’s the surgical FY1 on nights’ 

‘Hi doctor, a patient has a NEWS score of 10. Oxygen saturations are 63% on air’  

Just like that, I shot up, adrenaline coursing through my body. 

‘Shall we start him on 15L non rebreathe?’ 

‘Yes- I am on my way!’ 

I hung up the phone. My exhausted apathy from just moments before had completely dissolved and I was now gripped with panic as I hurried to the ward. My mind was blank. In that moment, all my medical school training seemed to have evaporated from my brain. I had no idea what to do next. I desperately tried calling my SHO but the phone rang out- voicemail. I realised they must be seeing patients in A&E. For now, I was on my own.  

Entry 2 

The omnipresent bustle of the day shift had subsided as I scanned through the notes of a patient I had been called to review. The more I read, the more concerned I became. His observations were worryingly abnormal and recent nursing notes reported multiple episodes of projectile vomiting. I had never assessed a patient alone out of hours, and I tried to drown out the imposter syndrome by focusing on the priority- safety. The nurse looking after him approached me and I noticed beads of sweat congregating on her hairline above a furrowed brow. As we entered the patient bay, we were greeted with a crescendo of raspy breathing, the hiss of oxygen doing little to subdue it. As I defaulted to my A-E assessment, the patient insisted he felt fine. But he was unable to say this in one breath. The glimmer of relief at his patent airway was short-lived. We needed more support, fast.  

I asked the nurse to put out a medical emergency call and contact the surgical registrar. Within minutes, the once quiet, sleepy bay became a teeming hub of specialists arriving in bursts from all corners of the hospital. Eventually the patient was taken down to ICU for further respiratory support and I returned to the sudden silence of the doctor’s office. My senior informed me the patient had Boerhaave’s Syndrome, and we talked through some learning points. However, I recognised I was still sitting in a whirlpool of questions and emotions. I grabbed my phone and messaged my FY1 colleague who was working on a different ward. We synchronised our breaks and joined forces in the doctor’s mess. I exploded with a vivid explanation of my assessment, a deep-dive of how I was feeling and an eagerness to hear her opinion. With each word, I felt the weight of intensity of the situation, which I had unknowingly carried with me from the ward, ebb away.  

At first glance, these two diary entries appear to be appear to be distinct and unrelated. However, they are actually written by the same FY1, on their first night shift, describing consecutive thoughts in the same scenario. This creative writing piece is intended to illustrate how the same doctor in the same situation can have a very different experience and/or behaviour under difference circumstances. 

In many ways, starting as a new FY1 doctor is exciting. Having a direct role in positively impacting patient outcome and experience is rewarding, the variety of work is stimulating and learning from patients and colleagues around you is inspiring. However, it can also be quite dauting. Self-doubt, burnout and low morale are not uncommon FY1 experiences, amongst others, and it can be difficult to motivate yourself. The FY1 writing this diary is experiencing all of the above, positive and negative. However, their response to stressors is distinct in each entry. *paragraph* In entry 1 there is an overriding negative, self-critical undertone with a primary focus on the difficult aspects of the night shift. They skipped their breaks and meals. When bleeped with an urgent job there is a switch to overwhelming self-doubt as panic and fear take over. In entry 2 the difficult aspects of FY1 persist but they manage to focus on fundamentals like patient safety and appropriate escalation. After dealing with this difficult scenario, they find a way to decompress, prioritising their wellbeing and taking away learning points. So how can we ensure we have this more sustainable and attractive FY1 experience? There is no single magic-pill answer as many aspects are out of our control. But there are things we can do to try and take back control. *paragraph* In the background of Entry 1, they are sleep-deprived, unable to plan time for hobbies and have been neglecting their well-being. In Entry 2 they have been prioritising their physical, mental and social health and so are a lot more resilient. Resilience is a trait talked about so often nowadays but can be difficult to achieve; it has become almost elusive. However, focusing on developing a solid grounding in perusing the things you genuinely enjoy, making time for people who you care about and minimising energy spent on anything that does not add to your life can make resilience much easier. In turn this can make a ‘good work life balance’ something more tangible. 

Dr Sejal Karmarkar

F1, Northern Foundation School

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