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The path to being a GP can begin as a hospital intern

Thinking back, my first day as an intern could have had career-defining consequences

If 1 July 2000 hadn’t fallen on a Saturday, I wonder would I have become a GP? I wonder would I have followed my original plan of being a surgeon, like my grandfather? In the years that followed, I convinced myself that I wouldn’t have enjoyed the black-and-whiteness of surgery; the beginning, middle, and endness of it. In my GP training interviews (of which there were many), I wittered on about “continuity of care” and “cradle to grave” and other such clichéd platitudes.

I was, and have remained, happily convinced that I much prefer community medicine with all its grey and fluffy edges, untidy and unsolvable problems, inescapable and inextricable ties, than the finite interactions between surgeon and a fibroadenoma with a human attached.

If 1 July had been a Monday, I might have started my medical career as a dermatology intern, meeting my calm, helpful and accommodating team at the bottom of the stairs in the South Infirmary, crisp white coat and shiny new stethoscope, ready to stroll the wards to see the only two inpatients on our list before heading off to the canteen for still-warm scones. I would have honed my scalpel skills on the elliptical excisions of non-threatening naevi and perfected my suturing with the relaxed warm supervision of an unharried registrar.

Instead, 1 July was a Saturday and I was rostered to be on-call. As a small concession to the gut-twisting terror that this induced, my fellow interns and I had agreed that we would split the weekend into two 24-hour shifts, thus reducing the abject misery to a simple matter of surviving 1,440 minutes with a heart rate of 150bpm. I don’t think I have ever been so terrified. We had had no practical training or guidance on how to survive the first day.

We had had no practical training or guidance on how to survive the first day

I think we may have shadowed an intern for a couple of hours the week before, in an effort to temper the dread. But this was off our own bat and we soon gave up, preferring to seek the comfort of denial in our last few mid-afternoon pints. So those first 24 hours were spent in a constant state of bewilderment, nausea, and regret, wondering how the hell I could have made such a foolish mistake with my life. I could have been pouring pints and having the chats. Instead I was staring at a small glass bottle labelled “Augmentin”, which had a white powdery substance at the bottom. In the other hand I held a syringe and needle.

I stared at the powder, baffled as to how it was going to make its way into the patient. I looked to the bottle for some guidance, but there were only numbers and dates. I finally found an unopened box at the back of the cupboard and fished out the instruction leaflet. Water! You add water! Of course! Having wrestled the lid off the plastic vial and finally steadying my hands enough to get the needle through the opening to draw up the fluid, I pierced the powdery vial and pushed. The first drops squirted in and turned the powder into crystalline clumps.

Hmmm. I’d deal with that later. I thumbed the syringe further in. Resistance. Push harder. Suddenly there was water on my face, dripping from my glasses, splattered all over the counter. My tears met the ‘augmentiny’ water on my hot cheek and trickled into the corner of my mouth. A nurse, wondering why the patient was still waiting for that sacred ‘first dose of antibiotics’, came to investigate. She sized up the scene quickly, took the vial from me and expertly completed the task in five seconds while explaining the process with a kind, but resigned air: “Did they not teach you this in college?”

The following June I made it my business to recruit the final meds into an informal ‘how to survive the first 24 hours’ tutorial, going through the basics of how to prescribe oxygen (“eh, can you not just write O2 PRN?”) and what to put into your little yellow tray when you go to stab someone’s wrist five times for that elusive ABG. I am pleased to hear that over the years the practical aspects of training have been incorporated into medical school, with fancy pretend arms and all sorts of simulation events.

I am sure the first day is still full of trepidation and anxiety, but hopefully today’s brand new interns aren’t contemplating injecting someone with co-amoxiclav crystals. And they may not develop a lifelong terror of hospital medicine on their very first day.

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