THIS IS WHAT IT’S REALLY LIKE TO BE A JUNIOR DOCTOR

Emergency A&E calls, ward rounds, witnessing life and death… Author Roopa Farooki shares what she has experienced during her first year as a junior doctor

Author Roopa Farooki shares her experience

I’d spent four years training in medicine, commuting three hours daily from the Kent coast to medical school in London, with all the stress and pressure that put on my husband and four children. All the guilt of being absent for the pick-ups and drop-offs. The worst placement in medical school was obs and gynae, because this involved catching a 4.30am train to get to hospital to start seeing patients ahead of theatre at 7.30am, and then all the horrors if something went wrong on the maternity ward. I was bringing babies into the world but not seeing my own, getting home when the children were either asleep or on their way to bed. That rotation almost broke me. I didn’t think I’d make it to Finals. I wasn’t sure I deserved to if I wasn’t tough enough for the job.

I trained in medicine after seeing my own children with debilitating eczema. I wanted to specialise in dermatology and help other people struggling with having their skin, faces and subsequent sense of self compromised. This would involve at least eight years of training in every kind of hospital rotation after qualifying as a doctor. My extended family thought I was mad; I already had a job as a writer and Oxford lecturer. I left a prestigious Royal Literary Fund Fellowship Scheme to start medical school at 39 years old.

When I qualified last summer and started working as a doctor in a hospital, I thought it would be easier. No more commute, just a short 10-minute drive or a long walk to the hospital that would allow me to spend most breakfasts and dinners with my family. I’d also worked hard and passed my Finals with great grades and had won a national prize from the British Association of Dermatologists. I’d toughened up. I deserved my place. It would be fine.

But reality bit before my first full day on the wards. On my shadowing day, I attended an emergency call in A&E with my team and a woman arrested suddenly, vomiting great ropes of blood. She died without her loved ones present, under our resuscitation efforts, during CPR. I went home and sat blankly on the sofa afterwards while the children bounced around and asked me to make them spaghetti bolognese. I chopped onions and tomatoes like a robot. They asked what was wrong and I couldn’t tell them. I didn’t know that woman’s name, but I knew she wasn’t much older than me. It was the start of a double life: work vs home. I couldn’t share the traumatic experiences or say anything about patients due to confidentiality. I couldn’t cry or complain. I still can’t. But the children know when I’m not their silly, funny mum, when I just sit down quietly with my tea after I’ve kissed them, that something has happened on the shift. ‘Did you lose one?’ they ask, without really knowing what that means.

The next day was my first official day as a doctor. I worked a busy morning of ward rounds and medical team jobs (such as putting in arterial or central lines, assisting tracheotomies, doing blood investigations and X-rays, referring patients to the cardiology or respiratory departments and rewriting drug charts). I was on the intensive care unit, which cares for some of the sickest people in the hospital – those who need constant monitoring. But at least there was always a registrar or consultant on the unit when blood pressure started diving or heart rhythms started fluttering on the screen. There was always a nurse by every bed. However, I didn’t have the same safety net in the afternoon when I was scheduled as the on-call cover for the two surgical wards, where I worked on my own with some deteriorating patients, helped only by a heroic critical care nurse. That evening, I was the only doctor across the two wards, desperately taking blood gases (taken from the radial artery, these tell you the oxygenation of blood and the lactate level, which are mandatory tests to diagnose sepsis) and blood cultures (a sample that tells you about specific bacteria in the blood so that you can prescribe the right antibiotic) from potentially septic patients, trying to cannulate swollen limbs

so I could give IV fluids. There were no surgical seniors – they were all operating in theatre – so I begged my intensive care registrar from that morning to help. When the night team arrived, they were unimpressed that I didn’t know the patients’ blood results and surgical histories by heart. My card had been mistakenly set up as a student medic rather than a doctor, so I couldn’t order all the appropriate tests, and they were unimpressed with that, too. I felt I’d done a lousy job, even though I hadn’t stopped for a moment, not to have tea or even pee, from 1pm to 9pm. I was just so grateful when they said I could leave. So, my first day as a junior doctor wasn’t easier than my training. Of course it wasn’t, and I was seriously reevaluating my life choices.

My next few months were mostly spent on the intensive care unit, and it was a good day if all the patients got through. Sometimes we lost patients who were unbelievably young – those with children, who had the misfortune to have a condition that just couldn’t be cured. I found it so hard to move on to the next patient after the last one had died, although I understood that caring for the living had to take precedence over mourning the dead. Was it really worth it? All this death and darkness, just to be a doctor? It’s much easier to be a good, compassionate doctor when you have time to sit and talk through the care with the patient and their families. One young man left the ward in anger because he felt he hadn’t been looked after, and there was nothing we could do. We’d investigated him thoroughly, diagnosed him correctly with a non-critical illness, managed his pain and given him his medications on time. We’d done our jobs, but that was all we had the time to do. He was afraid of the future, and we didn’t have a magic wand to take the fear away. But more time talking to him might have helped.

Have I changed in the year since becoming a doctor? Non-medical friends ask me if I’ve become blunted to death and tragedy. Medical seniors are surprised that I am not.

A patient arrested unexpectedly on my late shift last night. In the aftermath, I must have been visibly shaken, as the registrar looked at me with surprise. ‘It’s like you’ve never had someone die on you before,’ she said. I stayed back to see the patient’s husband, to talk to the daughter who had witnessed the medical emergency team charging on to the ward. I told them that she hadn’t suffered, that it had been quick, that we had held her hand. It was all true. And it all matters. Every small act of kindness. And that’s what it takes to be a doctor: not great grades and shining prizes, but kindness. When wards are closed with infection, the only people who go in to care for the patients are the doctors and nurses and healthcare teams. We risk our own health and that of our own families. If someone has an infection, we suit up and go in because it’s our job. I wish people knew how much the NHS workers give. I wish more people would join us, from all sorts of backgrounds, so we wouldn’t be under such pressure, and could provide better care.

Ultimately, you get up every day and do your best. You try to help each person you see. You try to do no harm. You’re horribly aware of your inexperience. In other careers, mistakes might lose money; in medicine, a mistake might lose a life. But there are small victories: someone finally turning the corner; someone getting better enough to complain about the noise at night; someone getting better enough to go home.

And occasionally, there’s a moment that makes it all worth it. On my last week on intensive care, a gentleman of 70 was rushed in after an operation that had discovered complications. We looked after him with everything we had on the unit. We sedated, intubated and ventilated him. I was supervised as I put in a central line straight to his heart. And a few days later, he was awake from his induced coma, bickering with his ‘little’ sister and chatting to his partner.

‘Thank you for looking after this young man,’ his partner said to the team as we went about our ward round. He was tearful. Radiant with relief. ‘We can’t tell you how lucky we are that you were there for him.’ ‘We didn’t do much,’ said the consultant. ‘Just our jobs.’ And at moments like these, I realise how lucky

I am to be in this privileged position. To save a life, and bring someone back to their family. To help, a little or a lot. One person at a time.

The Cure For A Crime by Roopa Farooki, the first title in her Double Detectives Medical Mystery Series (Oxford University Press) celebrating diverse girls in medicine, is out now. Roopa has donated part of her fee for this piece to the hospital charities in the Kent and London NHS Trusts where she has worked and studied