Confessions of a GP. Benjamin Daniels

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СКАЧАТЬ it’s Dr Daniels, vascular surgical house officer.’

      That’s right, my first job was as the junior in the vascular surgery team. I didn’t really know what vascular surgery was, but I liked the sound of it. Perhaps I could drop the house officer bit and just answer by saying: ‘Hi. Dr Daniels, vascular surgeon.’ Hmm, that would sound much more impressive. I could just picture the attractive nurse swooning on the other end of the line.

      To my surprise, at about ten minutes past five my pager did go off. I took a deep breath and answered the call: ‘Hi. Dr Daniels, vascular surgeon.’ There was a sigh from the other end of the telephone. It was my consultant and new boss. ‘You are not a vascular surgeon, you are my most junior and least useful helper monkey. Some poor bastard has popped his aorta and I’m going to be in theatre with the registrar all evening trying to fix him. I need you to order us a chicken chow mein, a sweet and sour pork and two egg fried rice. Have them delivered to theatre reception.’ The phone went dead. That was it. All those years of study and my first job as a doctor was to order a Chinese takeaway. Consultant surgeons have a wonderful way of ensuring that their junior doctors don’t get above themselves.

      Over the next hour my pager started going off increasingly frequently until it built up to what felt like a constant chorus of bleeps. Jobs that would take a few minutes for me to do now, took an hour back then because I was so new and inexperienced. I decided that the cocky doctor role didn’t suit me so I went for the pathetic vulnerable new doctor approach. It worked and the nurses soon began to feel sorry for me. They offered to make me tea, showed me the secret biscuit cupboard and helped me find my feet. Just as I was beginning to gain a little confidence, my pager made a frightening sound. Instead of the normal slow, steady bleep there was a stream of quick staccato bleeps followed by the words ‘Cardiac arrest Willow ward … Cardiac arrest Willow ward.’ To my horror, that was the ward that my consultant covered. That meant that I should really be there. I started running. The adrenaline was pumping, my white coat was sailing behind me as I zipped past people in the corridor. I was important. It felt great! Suddenly, as I got closer to Willow ward, a terrifying thought dawned on me, ‘Oh my God. What if I’m the first doctor there!!!! I’ve only ever resuscitated a rubber dummy in training exercises. I’ve never had to do the real thing.’ To my left was the gents’ toilet. Doubts began to race through my head. ‘Perhaps I could just nip in there and hide for a bit. I can reappear in a few minutes once the cavalry has arrived.’ It was tempting, but I bravely decided to keep on running and meet my fate.

      Lying in a bed was a frail old lady with her pyjamas ripped open and her torso exposed. She was grey and lifeless and I can remember her ribs protruding out of her chest wall. A couple of nurses were frantically running around looking for oxygen and the patient’s notes, while another nurse was doing chest compressions. To my relief, a remarkably relaxed-looking medical registrar was standing at the head of the bed and calmly taking charge. A monitor was set up and it was clear even to me that the wiggly lines on the screen meant that the patient needed to be shocked. A few other doctors soon turned up and I was pretty much a spectator as they expertly performed a few rounds of CPR (cardiopulmonary resuscitation) followed by a set of shocks. It was all very dramatic but the woman didn’t seem to be making any signs of a revival. Thinking that I had managed to escape my first cardiac arrest as an onlooker only, I began to consider sneaking away, aware of how many mundane jobs were waiting for me to be done on other wards. Unfortunately, the relaxed-looking registrar spotted me and called me forward. ‘This one’s not coming back; shall we let the house officer have a go with the defibrillator?’ I had just done my CPR training and it was all still clear in my mind. This was my big moment. For some reason, I had it in my head that if it was me who shocked her, she would suddenly come round. What a great story that would be, I thought as I stepped up to the bed. The one thing that the instructors had really emphasised in the resuscitation training was the importance of safety. I had to make sure that all the doctors, nurses and oxygen masks were clear of the bed before shocking the patient. I stepped up and took the paddles. Lifting them out of the machine I carefully placed them on the woman’s chest. Looking all around me, I started the drill: ‘Oxygen away, head clear, feet clear, charging to 360, shocking at 360.’

      BANG. My adrenaline had been pumping but I hadn’t expected that. I had stayed on my feet but had been thrown backwards with a jolt. That never happened with the dummies. I must have been looking slightly dazed and the registrar glanced over at me with faint amusement. ‘You’ve electrocuted yourself, you prat.’ Unfortunately, he was right. I had checked closely to make sure that the bed was clear of bystanders before I gave the electric shock, but I hadn’t realised that on running to the ward, I had shoved my stethoscope into the pocket of my white coat and as I was leaning over the patient, the nicely conductive metal tubes had been lying on the patient’s left hand.

      As if to rub salt in the wound, my first pathetic effort at resuscitation led the woman to go straight into asystole (flatlining) and the registrar called it a day. The correct thing to have done would have been to report my electrocution as a critical incident and give me a bit of a check-over, but instead the registrar just disappeared off the ward chuckling to himself. I had made his night and he called me ‘Sparky’ for the rest of my six-month spell at the hospital. I was left to carry on with the boring jobs on the ward and by the following morning everyone had heard of my disastrous first night. Perhaps it was an early indicator that I was better suited to the slightly less dramatic world of general practice.

       Jargon

      At my secondary school I was known as Benny Big Nose. Not the most charming of nicknames, but nevertheless a beautifully simple and succinct summary of my name and most prominent facial feature. I sometimes wish medicine could be as straightforward. Why do we use long-winded medical jargon to describe something rather simple?

      Purulent nasal discharge – snot; viral upper respiratory tract infection – a cold; infective gastroenteritis – the shits; strong urinary odour – stinks of piss.

      One reason for medical jargon is so that we doctors can write something in the notes that if the patient were to read, they wouldn’t take offence and complain. There was a time a few years back when patients had no right at all to see their own medical notes. I was recently looking through the old paper notes of one retired farmer and the sole entry for 1973 was ‘Patient smells of pig shit.’ How beautifully jargon free.

      When I first qualified, I loved all the medical jargon. I felt that it made us sound clever and elite and I got off on the fact that I could have a chat with a fellow medic on the train. However, it only takes an interaction with someone who uses jargon that you don’t understand to realise how annoying it can be. Current letters from our managers at the PCT (Primary Care Trust) have just this effect on me. What do phrases like ‘performance-based target strategies’ and ‘competence managed commissioning’ mean. They certainly don’t seem to bear any relevance to my daily routine of listening to people’s health grumbles and trying to make them feel a bit better.

      Patients are always happiest if you skip the jargon and say it how it is. I find that replacing the phrase ‘stage-four renal impairment’ with ‘knackered kidneys’ or ‘mitotic growth’ with ‘cancer’ is generally appreciated. We all like to have things explained in terms we can understand and I just wish that NHS managers would write me letters in a language that I could comprehend.

      It was Darren Mills who first named me Benny Big Nose. The last I heard, he was spending some well-deserved time at Her Majesty’s pleasure. His straightforward and direct manner seemed to get him in trouble from the teachers and later the police. However, Darren, if you’re out there, I’d like to say thank you for teaching me the valuable lesson of saying it how it is. You usually don’t cause as much offence as you think you might and most people will appreciate your honesty.

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