Adam Kay - This is Going to Hurt

Senior House Officer Post One

By August 2005, I was a senior house officer. I was obviously still extremely junior, having only been a doctor for twelve months, but the word senior had now been chucked into my job title. This was presumably to give patients a bit of confidence in the twenty-five-year-old about to take a scalpel to their abdomen. It was also the little morale boost I needed to stop myself jumping off the hospital roof when I first saw my new rota. It would be pushing it to call it a promotion, though it happens automatically after a year as a house officer, much like when you get a star on your McDonalds badge. Though I suspect Ronald pays

I believe its technically possible to fail the house officer year and be required to repeat it, but Ive never actually heard of that happening. By way of context, I count among my friends a house officer who slept with a patient in an on-call room, and another who got distracted and prescribed penicillin instead of paracetamol to a patient with a penicillin allergy. They both sailed through it, so Christ knows what you have to do to actually fail.

Senior house officer is the point at which you decide what to specialize in. If you choose general practice, you remain in hospital for a couple of years, doing things like A&E, general medicine and paediatrics, before moving to the community and being awarded your elbow patches and permanently raised eyebrow. If you choose hospital medicine, there are plenty of different roads you can stumble blindly down. If you fancy yourself as a surgeon, you can sign up to anything from colorectal surgery to cardiothoracics, neurosurgery to orthopaedics. (Orthopaedics is basically reserved for the med schools rugby team its barely more than sawing and nailing and I suspect they dont sign up for it so much as dip their hand in ink and provide a palm print.)

There are the various branches of general medicine if you dont like getting dirt under cardiology, respiratory or dermatology (which can be a revolting but relatively easy life you can count the number of times youd be woken up for a dermatological emergency on the fingers of one scaly, flaky hand). Plus theres a bunch of specialities that arent quite medicine or surgery, like anaesthetics, radiology or obstetrics and gynaecology.

I chose obs and gynae or brats and twats as it was charmingly known at my medical school. Id done my BSc thesis in the field, so I had a little bit of a head start, so long as people only asked me questions about early neonatal outcome in the children of mothers with antiphospholipid syndrome, which somehow they never did. I liked that in obstetrics you end up with twice the number of patients you started with, which is an unusually good batting average compared to other specialties. (Im looking at you, geriatrics.) I also remembered being told by one of the registrars during my student placement that hed chosen obs and gynae because it was easy. Labour ward is literally four things: caesareans, forceps, ventouse and sewing

I also liked the fact that it was a blend of medicine and surgery my house officer jobs had proved I shouldnt really be majoring in either. It would give me a chance to work in infertility clinics and labour wards what could be a better, more rewarding use of my training than delivering babies and helping couples who couldnt otherwise have them? Of course, the job would be difficult emotionally when things went wrong not every stork has a happy landing but unfortunately the depth of the lows is the price you pay for the height of the highs.

There was also the fact that Id ruled out every other speciality in quick succession. Too depressing. Too difficult. Too boring. Too revolting. Obs and gynae was the only one that excited me, a career I could genuinely look forward to.

In the event, it took me months to actually make up my mind, commit and apply. I think the reason I hesitated was that I hadnt made any significant life decisions since I chose which medical school to go to at the age of eighteen and even that was mostly because I was impressed with the curly fries in the students union. Age twenty-five was the first point I actually got to make an active decision in the Choose Your Own Adventure book of my life. I not only had to learn how to make a decision, but also ensure I made the right one.

You decide to pick up the forceps. Turn .

Monday, 8 August 2005

First week working on labour ward. Called in by the midwife because patient DH was feeling unwell shortly after delivering a healthy baby. Nobody likes a clever dick, but it didnt take Columbo, Jessica Fletcher and the entire occupancy of 221b Baker Street to work out the patient was probably feeling unwell because of the litres of blood cascading unnoticed out of her vagina. I pressed the emergency buzzer, hoped someone a bit more useful would appear and unconvincingly reassured the patient that everything was going to be fine, while she continued to redecorate my legs with her blood volume.

The senior registrar Once it was coaxed out, and the patient had a few units of blood replaced, she was absolutely fine.

I went to the changing rooms to get myself some fresh scrub trousers. Its the third time in a week my boxers have been soaked in someone elses blood and Ive had no option but to chuck them away and continue the shift commando. At 15 a pop for CKs I think Im running my job at a loss.

This time it had soaked through further than usual and I found myself washing blood off my cock. Im not sure which is worse: the realization I could have caught HIV or the knowledge that none of my friends would ever believe this is how I got it.

PV is a per vagina examination. PR is a per rectum examination, so do always clarify when somebody tells you they work in PR.

If theres anything left in the uterus after delivery placenta, amniotic membranes, a Lego Darth Vader the uterus cant contract back down properly, and this causes bleeding until the offending item is removed.

Saturday, 27 August 2005

Accosted by a house officer to come and take a look at a post-surgical patient who hasnt passed urine I tell the house officer that I havent passed urine in the last eleven hours because of people like him wasting my time. His face crumples like a crisp packet in a fat kids fist and I instantly feel terrible for being mean to him that was me a few months ago. I slink off to review the patient. The patient indeed has no urine output, but thats because the tubing from her catheter is trapped under the wheel of her bed and her bladder is the size of a space hopper. I stop feeling terrible.

Doctors are obsessed with urine output though not in the kind of way that would make you rethink going on a second date with them its how you tell if the patient has a low blood volume. This is particularly bad after surgery as it could mean theyre bleeding somewhere or that their kidneys are rogered, neither of which are great.

Monday, 19 September 2005

First ventouse delivery. I suddenly feel like an obstetrician its a pretty notional job title until you can, you know, actually extract a baby. My registrar, Lily, talks me through it gently, but I do it all myself and it feels fucking great.

Congratulations, you did amazingly well there, says Lily.

Thank you! I reply, then realize shes actually talking to the mum.

Wednesday, 21 September 2005

Signing a stack of letters to GPs after gynae clinic when Ernie, one of the registrars arrogant but funny with it strides in to borrow an examination lamp. He peers over my shoulder. Youre going to get struck off if you write that. Change it to pus-like or put a hyphen in there somewhere.