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Day in the life of an F1 in gastroenterology

Dr Gemma Lysycia charts a busy day in a gastro ward

7:00

Rise and shine. It’s day 5 of 13 and I’m shattered already. I don’t know how I will keep this up.

8:30

I arrive at the hospital. As I put my bag in my locker, my bleep goes off: “Cardiac arrest! Cardiac arrest! X Ward!” That’s my ward! I shove my bag in the locker and whirl around in the direction of the ward. As I begin to run it dawns on me that I’ll probably be the first doctor on the scene – I start to get that sinking feeling. While running I ask a receptionist: “Which room?” Opening the door I see a patient on the floor and two nurses leaning over. ABCDE, it happens automatically, a system drilled in at medical school and thank goodness it was. By ‘E’ the medical registrar has arrived – thank goodness.

The incident means that I’m already behind in preparing for the ward round. I stare at the whiteboard: four new patients? How did that happen overnight?! When the ‘sleep out list’ arrives I discover my team has medical patients under my consultant that are on surgical wards due to a bed crisis. Eek it’s going to be a busy day.

Opening the door I see a patient on the floor and two nurses leaning over. ABCDE, it happens automatically, a system drilled in at medical school

9:25

List updated and bloods requested. The team arrives and it’s ward round time. I find multitasking is best tested on a ward round. The hardest thing by far is documenting in the cumbersome notes, without a table to lean on. Either I balance on ‘my hand’ or take an awkward stance of standing on one leg and using the other as a table – quite comical really.

Midday is fast approaching and I nervously wonder if we will finish the ward round before then. Seeing patients during ‘protected meal times’ will surely mean a stern word from the ward sister.

During the ward round I always highlight which patients are on warfarin and insulin – that way I don’t forget to prescribe it. I’ve also found it’s good to check if prescription charts are nearly finished. Being bleeped when you are on call to rewrite a prescription chart is not fun.

12:00

Phew; ward round done and I gulp down caffeine. The phone rings. “Hello did anyone bleep the emergency Catholic priest?” “Anyone bleep a Catholic priest?” I say loudly, whilst still typing my discharge summary and hoping someone comes. I’m too busy to even question the phone call, only three months into the job and already very little surprises me. Do all hospitals have an emergency Catholic priest?

Off to bed 12 to write in the notes, the patient looks different… What? The patient has gone to the discharge lounge? A prime example of why it is important to check names before doing anything.

Now it’s task time. Poorly patients come first, this is followed by a long list – requesting imaging/investigations, writing referrals, cannulation, venepuncture and invariably discharge summaries. It’s impossible to walk the length of the ward, however, without being asked a question by a patient or member of staff. Not that that’s a problem, it just means you have to factor that in to your time management.

Throughout the day tasks get completed as others present themselves:

  • “Mrs A has a rash under her arm. Please review”
  • “Mr P hasn’t opened his bowels in four days”
  • “Miss G says her eyes are blurry”
  • “A patient has been admitted from clinic and needs a full clerking”
  • “QUICK QUICK, the patient’s unresponsive!”
During the ward round I always highlight which patients are on warfarin and insulin – that way I don’t forget to prescribe it

14:00

BLEEP BLEEP – once every 30-40 minutes my bleep goes off. I search frantically every time for the golden list containing the ward round tasks and my pen in its nest in my hair.

18:00

Jobs completed, time to check bloods. Another job sat at a computer and therefore appropriate to grab a quick coffee. “What? Mrs A didn’t have her blood taken? And she’s loading on warfarin.” Off to take her bloods then…

18:30

List updated, bloods for tomorrow requested. I’m on call so time to go to MAU to clerk in patients. Chest pain, pyrexia, collapse – these patients haven’t got a diagnosis and tend to require more focus.

Seeing patients for the first time and talking through my management plan with a senior is both rewarding and educational

Chest pain, pyrexia, collapse – these patients haven’t got a diagnosis and tend to require more focus

21:00

Handover. The end of a busy evening treating lots of unwell patients.

22:00

Home, famished, exhausted. Off to bed ready for my 9:00 – 22:00 shift tomorrow. Can I keep this pace for another eight days? Who knows?

Would I change it? Never.

Dr Lysycia is currently doing breast surgery at Lancashire Teaching Hospitals NHS Trust.