In your final year as a medical student in Nigeria, while you prepare and are being prepared to make the transition from medical school to medical practice, one of the goals of your teachers is to equip you for your first day on call as a house officer.
You will often hear case scenarios like this: “It is your first day on call as a house officer in the accident and emergency ward. A 25-year-old lady is rushed in. She is anxious, in painful distress and bleeding per vaginam. Her pulse is weak and blood pressure is 90/60 millimetres of mercury. How will you manage this patient?”
Your teachers need to be assured that you can be trusted with the lives of patients. As a house officer, you are the first doctor on call, that is the one whom patients come into contact with first. This is the reason every final year medical student must be armed with initial resuscitation and stabilization skills.
I have often wondered what my first day as the house officer on call would be like and prayed to have a good one. Today, four doctors share their experience. Enjoy.
Dr Momah, J. E.
- Works in Central Hospital, Agbor, Delta state.
My first day on call was not as bad as I envisaged. As a matter of fact, it wasn’t bad at all. It was what I hoped it would be like. Even though it was hectic, I enjoyed every bit of it.
It was on the 1st of January (New Year’s Day) and was to last for 24 hours (from 8 am on the start day to 8 am the following day), and of all the newly employed house officers, I was the first to be on call at the Accident and Emergency (A & E) department of the hospital.
The thought of having a call on such a busy day and in the A & E would make one hesitate to get out of bed for fear of the unknown.“What if I kill people?” was the predominant thought on my mind the day and night prior to my call day. But I also knew I had to be confident in myself because I passed all my exams myself.
So, the morning of the call day finally came and amidst mixed feelings of trepidation and excitement, I prepared. I made sure I had breakfast before leaving for work. I got there on time to meet the youth corp I was on the call with and other corps too (they were there because, apparently, A & E is the most active part of the hospital). Seeing them made me feel safe.
The cases we had earlier were minor cases like exacerbation of peptic ulcer disease, upper gastrointestinal bleeding, acute watery diarrhoea and hypertensive emergencies, but we knew at the back of our minds that more serious cases, like road traffic accident victims, would be coming in towards evening – the peak of the new year celebrations as there’d be lots of reckless and drunk drivers.
True to our thoughts, they started coming in from 5 pm; people with open fractures, deep and wide lacerations on different parts of the body (just above the eyes mostly), flooded the A & E, and to say we were overwhelmed with the amount of blood in the A & E that day would be an understatement.
We quickly swung into action and thank God for the 3 or 4 corp doctors asides me and my medical officer on the ground, we were able to carry out every task to the best of our abilities.
I sutured a real wound for the first time, made decisions on my own when my medical officer was too busy to listen to me, and we were literally busy throughout the night such that we had no sleep.
It was daybreak at last, and I couldn’t wait for it to be 8 am so I could go back home and wash off. At this time, I was already stained with blood. When the time to leave finally came, we handed over to the next set of persons on the call and wished them good luck. As I was about leaving the A & E, I looked back, thanked God we didn’t have any casualties and happy that I came into this profession to save lives, and that gave me the utmost satisfaction.
Dr Agwu, K. N.
- Works in Federal Medical Center (FMC), Owerri, Imo state.
I would rather rephrase the topic to my first weekend as a house officer. I reported excitedly to work on a Friday in hopes that I would resume fully on Monday, but to my greatest shock, my firm was on a weekend call. The dreaded weekend call that starts from 8 am on Saturday and ends at 8 am on Monday. There I was, feeling fresh and cool with myself, not knowing the enormity of the task ahead of me. Oh, I forgot to add that I had only two shirts with me. So, I needed to hurry home and get a few of my clothes that would, at least, last me through the week. I set out for Aba that evening and returned by 8 am the following day.
On arriving, I was told to man the labour ward. In the labour ward, asides from the odour of liquor that immediately fills your nostrils, the screams from women in labour is the next hard thing to miss. “Doctor, this thing is painful oh! Please, doctor, give me something for the pain.” Actually, where I trained we give pain relief to women in labour, but it was quite different here. I simultaneously monitored five women in labour. And it wasn’t a fun experience. The sixth woman came in with poor contractions necessitating augmentation of labour. The most dreadful work in the labour ward is to augment labour, which entails titrating oxytocin in an infusion at a particular drop per minute, checking maternal contractions, and listening to fetal heart rate. And to think that I had to use a fetoscope in this day and age.
Of the six women, three required an episiotomy, and it’s the job of the house officer to repair the cut. All of these I had to do in one night. Thankfully, I had already started imagining how to repair an episiotomy. So, after my *chief did the first two, I took on the third and did a great job at it. I was proud of myself. The nature of my call duty was such that I neither slept nor took a bath until the evening of the next day.
Dr Uzochukwu, C. O.
- Works in Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun state.
I was one of those medical students who did not give thoughts to their first day as a doctor. I guess I was too busy thinking about getting done with house job and moving on to the next phase.
My first day as a doctor was not memorable. It was one of those days in which you sit through presentations. There was nothing interesting or clinical about the day.
A few days later, however, I was added to the call roster. I had palpitations, I must say. I had heard brutal stories about ward covers. Internal medicine is infamous for a large number of patients that die. I wondered, “What will happen if I get that your-attention-is-needed-a-patient-is-gasping kind of call?”
Another worrisome thought was setting intravenous (IV) lines. I am afraid I am one of those persons who did not attempt it in medical school. Most of the patients I could have tried it on had infectious illnesses. “I cannot come and kill myself when I am not yet earning a salary,” I would say then and pass. But I did try my hands at setting some lines before my first call duty. It wasn’t so bad after all. I also did a pilot call duty with someone to ensure I was not clueless when left alone.
When the day finally came, it was a summary of random blood glucose checks at 5 pm and 5 am, which I did excellently, and numerous IV lines I had to secure. Suffice it to say the latter patients had to be pricked more than once.
Thankfully, I didn’t get any of those your-attention-is-needed-a-patient-is-gasping phone calls. They came in subsequent call duties. I did get phone calls with minor complaints that did not require more than I was capable of doing, and when the clock finally got to8 am, I heaved a sigh of relief! I survived my first call!
Dr Okeke, C. B.
- Works in University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu state.
I was actually relaxed about starting my house job in Internal Medicine. I had just finished my final MBBS. So, I would be able to cope with the questions, I thought. Plus, I was also posted to “my usual unit.” Somehow throughout medical school, and now house job, I was assigned to Nephrology unit.
With grace on my side, my first call duty was to cover the male medical ward. I was not jittery about it. Like, I was thankful it wasn’t the Accident and Emergency ward. With the incidence of Lassa fever, the emergency is nobody’s happy place. For Pete’s sake, I have only just begun. I love my patients, and I know I will eventually face it, but please, not on my first day.
The call duty was to begin at 4 pm. As a routine in my centre, we are to sign in at the emergency ward with the supervising registrar before dispersing for duty. I was present at 3:30 pm. First call, initial ginger, and well, good first impression.
My registrar gave me some IV drugs to administer before I was to leave. That was easy. We gave drugs occasionally while doing calls as students. I rushed to the patient without gloves and was quickly corrected by a nurse. You can’t imagine I forgot to protect myself.
Headed toward the wards, I said a quick prayer that I would have no casualty. It would not be funny certifying a patient dead in the middle of the night on my first call.
I did my rounds, greeted each patient at their bedside with an encouraging smile, and looked through their charts. One could literally read the joy off my face when there was no IV drug to be administered.
At the first and second cubicle there were already “sweet, patent IV lines,” and all I had to do was push the drugs through them, and inform the patient I would return at the time of their next dose.
Then I got to the last cubicle. If you are a doctor, you already know what happens there. There were two men there with IV drugs to be given; one with no line and the other with a tissued line.
Lord, so my first trial at setting a line would be in the last cubicle? And there I was evading Lassa fever in the emergency.
I called my registrar and she told me to at least try and not give excuses in order that I learn. Besides, I signed up for it.
So, I triple-gloved and did all I could, pleading “the blood of Jesus.” I succeeded with one but not with the other, and didn’t want to inflict more pain on the patient. Besides, I was doing this with torchlight. Welcome to medicine in the tropics.
I completed the rounds in about 4 hours. By 8pm, I could take a break, stretch my legs and eat. It was a quiet call; I had no blood transfusions to administer, no drug reactions, no titrating hourly insulin for diabetic patients, no need to collect samples for an urgent investigation, no death, and no reason for alarm. But it was truly a long night because I was not able to sleep. And oh! I injured my thumb breaking a drug bottle manually.
You can only get better with practice I told myself. I was called to save lives and I am glad I could help the little way I could. By 8 am, I was done. With my eye bags but so much joy in my heart, I rushed to freshen up. Ward round was at 9 am and there was no reason whatsoever for lateness.
There you have it: Four doctors with their unique experiences.
Are you a doctor/medical student? Can you share your experience/thoughts on the subject with us in the comments? Are you a non-medic? Please feel free to join the conversation by sharing your thoughts too.
*Chief – Medical jargon used to refer to a senior in the profession.
Ps: If you would like to be featured on the blog or write a guest post for us, leave us a message here using the contact/collaborate form.