An Excerpt from the Novel

July 1st, Wednesday

As most new beginnings in medicine go in Ireland, this was no different; a sense of expectation and a generally upbeat mood suffused the drab, linoleum floored room. I twiddled my pen and took mental notes. A couple of Irish SHOs – one step above me in the pecking order – and the odd Registrar milling around in a sea of foreign graduates and doctors. Dollops of white and ginger cream in a mixed curry of staff, as it were.

Orientation started late. No surprises so far then. The ‘orientation’ was possibly more depressing than showing up on a blind date to find Mary Harney sitting across from you. At least you could expect desert (and if anything happened later she would be sure to swallow). I don’t think there was a single smile or a “Welcome to Drogheda” throughout the ill-prepared presentation. A better setting might have been the cemetery across from the main entrance of the hospital.

Brilliant. No real flow to the proceedings, just a heads up from the administration about how the future changes at the hospital would affect us (i.e. you’re fucked) and how if we all worked together (i.e. without overtime pay, together) everything would be fine. In essence the administration escaping to fight another battle over budgets for the next year before the doctors leave in six months time and forget.

Jesus I’m cynical; it’s 08:30 on my first day.

Oddly enough, the room for orientation was the same room in which I was sequestered for over four hours before royally messing up my final exam; I was shocked they passed me after the tragedy of my final oral but hey; nice to be in familiar surroundings. I think the interns from MEMS (my alma mater) were a bit less stressed than the three newbies from Trinity. I wonder if orientation was any more organised in the big Dublin hospitals or down in Cork or Galway? If only I had spent more nights at the coal face prepping for the finals instead of pinting I might not have received the honour of lowest ranked spot for intern year and my last choice; to be honest, I couldn’t remember ranking this place at all.

We were probably more confused than before after the talk. With the lustre of our initial euphoria – ‘interns at last!’ – dulled somewhat after a mere hour in the hospital, it was off to meet the consultants and our teams. Mine fit the description of rural medical teams in Ireland; consultant from Pakistan (rare), registrar from Mauritius (more frequent), SHO from Pakistan (common), and the bottom of the pile; me.

During orientation I eventually received my bleep. I was desperate to get my first message, excited to be of use after years of skiving around hospital in everybody’s way. I was a initially jealous of other people getting bleeped, eager for some of the action. Important stuff needed to be done; stuff like rewriting a drug chart or replacing an intravenous cannula, charting suppositories and patting patients on arthritic shoulders.

Finally, I received my first bleep; but then had to ask around as I had no clue about how to actually answer it. It was exciting for the rest of the day and quite a change from being a medical student. No more dossing off on half days back to Dublin, sleeping in and having a full Irish breakfast at the country B&B after one hour of radiology tutorials in the morning. Didn’t mess anything up that first day that I can think of but they really should move the start date to a Monday afternoon and give us the weekend off to organise moving house and cities for the new jobs. And to sleep in and get a full Irish breakfast.

Still didn’t feel like a doctor at all, the haemorrhage of knowledge over the summer and, dare I say, during final medical year actually made me feel much dumber than I was during 4th year. At least my printing is still relatively neat and tidy.

Finished work at about 5pm and it was home to continue unpacking and moving stuff from one corner of the apartment to another; thence to bed. My first day of real work as a valued member of a meritocratic, opportunity-laden society. Didn’t kill anyone either – not too shabby.

July 2nd, Thursday

What a fecking day.

I have LOTS to learn about this hospital and how it works. Last summer I spent a month in America, outside Boston, doing an elective in an Accident and Emergency department. They had 24-hour in-house Emergency Department CT scanners with sanguine radiology staff there all day and night. You can imagine my surprise then on commencing work for the HSE.

I didn’t put in a CT request for a patient until 4:15pm. This was the first chance I to breathe all day. The guy was a local farmer and likely one of the soundest guys in western Europe with a child awaiting treatment for some blood disorder sitting waiting for him at home. He sat in A&E the whole day and only asked the nurses twice what the story was about getting his scan. Bottom line, my failure to submit his form earlier had led to a slightly prolonged wait – an entire night and into the next day.

I don’t think I have to explain to anyone how bleak an emergency department becomes after twelve hours. I hope he at least got an occasional cuppa. I felt so bad and apologised effusively. I wasn’t appreciative of the fact that CT services stopped at 4pm unless a consultant requests it (this plus the warming up of the machines, the time for scan, the inherent possibility of further imaging etc etc). Ultrasound requests were also a mess – it took forty-five minutes to book two scans. It’s odd that when you go to book a scan (which your consultant has specifically asked for) your clinical judgement is always questioned; perhaps nothing wrong with that in some respects.

But why the confrontation? I’ve no issue running a request by radiology and getting their input but a “good morning” and “thanks” from their side would be nice. Let’s be honest, a new intern doesn’t have much of a clue about the scan but they know a consultant with forty years’ experience wants it. And that they want it done today. Of course they can’t request it themselves; that’s what muggings here is for. Feck.

My registrar, Dr Khan, was super helpful. Everyone was a bit tentative the first day and he really should have ripped me a new one for my lack of prioritising but he was almost too nice. It’s a quick learning curve to understand the new system and the tasks that need to be done but hopefully after the next week things will settle a bit. Nurses were generally quite helpful and understanding that we were just starting as interns and basically knew nothing about clinical medicine nor how to be an intern.

Flow-sheets. Wow. What a waste of time. Every patient’s blood results tabulated daily, handwritten onto a paper sheet. Great to have the results at the bedside but in this day and age there is surely an electronic solution. Plus it might save me from carrying around a dorky binder on ward rounds. I finished updating them all at 10pm after which I wearily made for home. It wasn’t until I got back to my couch that I realised my entire intake for the day was 2 cups of tea. Jesus. Can’t wait until the European working time directive kicks in and we have to take lunch breaks and work normal hours.

One of my co-interns, Aaron asked me to help get bloods on one patient and I actually managed it first time. It’s not fun going into a room with a pin-cushioned patient covered with cotton balls and tape from previous assaults and pretending that you’re going to have more luck than your equally inaccurate colleagues. A growing gripe of mine is the fact that nurses won’t do bloods or IV cannulas because they aren’t ‘certified’. Not that a single non-consultant hospital doctor (that’s NCHD) in the country can produce a certificate saying he/she is qualified. It’s just practice and hey, hopefully someone showed you how to do it in medical school.

It was a good thing that I learned all that stuff back during a rotation in Navistan so I was semi-useful I guess. Need a bit more practice and calmness though. Had a good chat with some patients and that made the day much more fulfilling. It’s an amazing opportunity to hear about their lives and instantly connect by being their physician. There is still a wall there, something quintessentially ‘Doctor-patient’ about the whole thing but I think made an elderly gent smile and a terminal lady laugh once or twice . It was the only medicine I had for her.