Our journey through life is peppered with “firsts”. From unrecollectable first words, to the first day at school, to our first kiss and beyond; these unique experiences stay with us and influence us forever.
Even with advancing years there are still many firsts to experience, both personally and professionally and I recently had one in the latter category. For the last few years I have been doing training shifts as part of our local prehospital team on the Air Ambulance. I came to this rather late in my career, so despite my senior status in the ED went back to being a trainee in a very foreign environment. Critically ill patients were no longer arriving to see me in a brightly lit resus room lying on a trolley at a convenient height for assessment, but instead were trapped in cars on rainswept country lanes.
After a long period of training and assessment I was finally ready for my sign off day; a consultant still with me, but assessing me and to offer assistance only if I really, really needed it. I had to be able to do it on my own.
The sign off day progressed without alarm or major incident, until we got a call to a RTC with two casualties, both with major injuries and requiring urgent airway intervention. Arriving at scene, the team had to divide and I took the lead for one of the patients – a middle aged man with a severe head injury, probable facial and limb fractures and hypotension, whilst my senior colleague looked after the critically injured child. I’d prepared for this moment for weeks and even when not on shift had practised what needed to be done, both in simulation and mental drills. I’m a confident trauma team leader in the resus room and my EM training had included long stints in anaesthesia and intensive care, but this was still very different. Very new. My first.
All went fine and the patient’s airway was safely secured, prehospital blood transfusion commenced and he was transferred without incident to the Major Trauma Centre. I tried to appear cool – like this was something I do every day, but really I felt a mixture of relief, exhilaration and anxiety. Had I done everything right? Had I given him the best treatment I could? When it cane down to it, was I up to it?
— Dave Jones (@WelshGasDoc) July 28, 2014
This week Emergency Departments across the UK will be full of doctors who will be feeling exactly as I did on that day. In an alien environment, trying to do their best, but surrounded by firsts – the first patient with chest pain, the first sprained ankle, the first unexpected death. For those of us for whom the ED is a second home it is easy to forget how intimidating a place it can be. This group of doctors will be the twentieth I have worked with since becoming a consultant and I will give them (almost) the same talk about syncope I have given all of the others. For me it is just a case of history repeating, but for them every new encounter is a first. Each case they assess will present new challenges and it would be all too easy for me to forget and get exasperated at how long it takes them to tell me the history or become frustrated at explaining why they don’t have to always wait for the blood results to make a decision about the patient’s care.
Every time I can feel myself rushing one of these doctors (who, let us not forget, are some of the brightest of their generation) I’ll think back to that day as I waited for the induction agent to take effect as the sun beat down and the paramedic team looked on expectantly, and how that “first” felt for me.
Our patients will keep coming to see us, targets will still have to be hit and the pressure that we are so familiar with will continue, but we mustn’t forget that for some of those working with us this is very new, hopefully exhilarating, probably exhausting and just a little overwhelming. And this twenty first group of doctors deserve all of the attention, care and understanding I gave the first.
You might also want to watch this excellent video from the Short Sharp Scratch team who interviewed foundation docs on their experiences as junior docs.