My first Med Reg Shift

My first registrar shift at The New Hospital was, well, interesting. I've actually been working as a Med Reg on and off for a while. So the first Med Reg Shift actually happened in a different hospital a long time ago. 

I had been holding the Med Reg Bleep for half an hour when I got a call from A and E. There was someone in who was in Type 2 Respiratory Failure easy enough, I knew how to set up NIV. I got her stablised and all seemed well. 

Just as I was back on the admissions ward, thinking how nice it was to be a Registrar I got a phone call from the A and E consultant. As an SHO I knew what A and E consultants wanted: they wanted me to admit their patients as soon as possible so they wouldn't breach the 4 hour target. Now he seemed to want my medical opinion. 

We had a patient - who seemed hot and sweaty with a very very low blood pressure. We weren't entirely sure why. Her ECG was an (Old) Left Bundle Branch block - so we couldn't tell much from that - sure an acute MI could cause this, but we had no way of telling whether it was old or new. 

We thought he might be septic - have an severe infection - so we gave some fluids and antibiotics, we persuaded a radiologist to check he didn't have a burst aortic aneurysm. 

We eventually worked out that he must be septic so we wondered if we should give inotropes - drugs that make the heart beat stronger,  the A and E consultant didn't think ITU would take him, but I thought if he was septic we should try inotropes. The ITU consultant came to see him and did agree we should do everything- I remember being pleased that I was making a valuable contribution.  

Then the blood tests came back and the cardiac enzymes were sky high: this meant that he had damaged most of his heart. The on call cardiologist thought it was too late for angioplasty so we gave some inotropes and transferred him to ITU. 

That all seems straightforward now, but at the time I just remember how alone I felt. I kept wanting to bleep the med reg, I think at one point I got as far as picking up the phone. 

I became a Doctor because I wanted to deal with sick people, I thought I would find it exciting. But it wasn't exciting, it was horrible. 

So why did I go back?

Partly because it was too much hassle to change career track and do something with less acutely ill people in it. And partly because as I got more confident I realised I could get people better at times, and that was satisfying.