So. You’ve passed finals. Congratulations! You’re understandably pleased with yourself. It’s a big achievement. Probably, if you’re like us the biggest of your life. But – and it’s a big but – that happiness is probably a little bit tainted. There’s a big cloud on the horizon – that first day of work! August the First! D-Day!

It’s exciting – course it is – after all it’s what you’ve wanted for as long as you can remember. You’re finally going to be a doctor. You’re finally going to start dragging in some money. You’re finally going to be able to start bragging to your mates. Finally going to find out if you really can get free flight upgrades!

But things will change. Gone are the days of late morning starts and early afternoon finishes. Gone are the days of keeping up with the plotlines on Neighbours.

Instead, in are the days of responsibility, real life and death decision making, resus calls, post take ward rounds and writing case reports at 3am in the morning half way over the Atlantic (without the upgrade!) to keep your CV in the black.

In short it’s scary stuff. You’re going to be worrying about all sorts of things – some of them justified – some of them just daft. Everybody thinks they aren’t going to be up to the job – but in reality most are. You’re going to discover a lot of things you don’t know and also a lot of things you never knew you knew.

We thought it’d be helpful to stick a few of our experiences down on paper. Some from our first day, and others from six months down the line. Hopefully we’ll give you some idea what to expect and hopefully some idea how best to prepare.

First Day

I prepared for my first day the same way I’ve prepared for every big day in my medical career – cheese on toast, a cup of tea and a desperate flick through the Oxford Handbook to remind myself how to treat hyperkalaemia and what in the hell is pseudopseudohypoparathyroidism. Quite why these things are always at the forefront of my mind at such times has always been a mystery but I can’t help it. Of course I knew the chances of coming across a patient with pseudopseudohypoparathyroidism on an orthopaedic ward were slim to say the least – but I just can’t help myself. The same way I can’t help but laugh every time anyone mentions a toxic megacolon.

As it happened I had no opportunity to show off such knowledge. In fact I had little opportunity to show I had any knowledge at all. I was one of the unlucky few to be post-take first day so I spent the brunt of the morning seeing a flurry of new patients with the consultant and then most of the afternoon trying to remember what I’d been asked to do with each of them. I could barely remember where my own ward was let alone whether it was Mrs Smith or Mrs Jones who needed that PCA putting up!

Without your patient list you are nothing. Those little boxes with ticks through them looked pretty stupid to me as a student but they really do save lives.

Sounds basic stuff – but basic stuff is exactly what you learn on your first day because basic stuff is exactly what you don’t get taught at medical school. I never got taught about fluid regimes or pain pathways. I never got taught what the best laxative or sleeping tablet is. I had no idea which of those two wounds I could safely allow to go home – to be quite honest they both looked pretty horrid. Both hurt when I prodded them. That was about the extent of my knowledge.

The key to remember though is that the important things you already know. You’ve already learnt them. That’s what finals were for. After three years of clinical medicine you’ll have seen a lot and you’ll have been examined on most things at least twice – it’s amazing what sticks.

You know how to treat an acute exacerbation of COPD, you know how to deal with ACS and you can probably have a pretty good shot at any medical emergency. You may be a little sketchy on the details and you’ll definitely be lacking in self-belief but you can almost certainly steady the ship until senior help arrives. And after all you’re not there to solve every problem, you’re there to initiate the events and procedures which can. This you can do - you just need to prove it to yourself.

I thought I’d got away with it on my first day. Admittedly I felt pretty useless – I’d struggled with seemingly the most basic things – but nothing had gone wrong, no crises had occurred. I’d spoke too soon. Just as I was about to slope off one of my patients thought it’d be a good time to began throwing up copious quantities of coffee ground vomit. Great! What am I meant to do about it? I can’t remember a damn thing about anything.

First things first – ABC – well he’s clearing his airways – anyone who can swear that profusely isn’t struggling to breath. SATs good. BP fine. Pulse a little high but not as high as mine. And how do you miss a vomit bowl from 6 inches?!

So what are the causes of haematemesis?

Never mind – he needs a venflon – I haven’t put one in that smoothly since, well ever.

What’s that tube thing called you stick down their neck?

Never mind - a bag of saline would go down nicely than you very much.

I actually did know what I was doing - in between the moments of sheer panic. I’d done my ABC, got venous access, sent off some bloods, taken a brief history, a quick examination and started fluid resus. I even knew what I had to give next – IV esomeprazole – I just had no idea of the dose, which I was frantically looking up when the SHO careered onto the scene (fast-bleeping is great!) and took over.

I went home feeling happy and fulfilled!

Eight Months In

Well now I’m eight months into the job and things are going well. I know most of the people in my hospital, I’ve got a pretty good idea of what I should be doing and I understand my role in the hospital - it’s no coincidence that house officer abbreviates down to HO!!

Most of the time it’s enjoyable stuff but there’s a lot of paperwork - discharge summaries, writing in notes each time you see a patient, documenting ward rounds etc etc. This can get a bit frustrating if you’re like me (can’t scribble very fast!), you need to get very good at writing the salient stuff quickly - your SHO and SpR should help you out with this early on. You’ll soon find a couple of seniors who document in notes well – copy their style and make it your own - it’s hard to stress just how important documentation is. There are horror stories of F1’s through the years being questioned under caution - or worse, simply because of poor – or sometimes no - documentation. I don’t intend to scare, it’s just something that I’ve had drummed into me from day one. Plus it won’t be long before you pummel your head against a wall because someone has seen your patient overnight and not documented anything remotely useful, leaving you none the wiser next morning. Good note writing makes everyone’s life easier.

There are horror stories of F1’s through the years being questioned under caution - or worse, simply because of poor – or sometimes no - documentation. I don’t intend to scare, it’s just something that I’ve had drummed into me from day one.

There’s a fairly limited number of ward complications in surgery. You won’t see many cases of pseudopseudohypoparathyroidism (damn!) – but then who needs to know about that anyway, unless you want to be an endocrinologist! What you will see is plenty of patients with low sats or hyponatraemia or high BMs and every doctor – regardless of speciality – needs to be able to manage these complications.

The only time I’ve really felt scared – like I can’t cope - is on call and even in these situations it’s not been as bad as I’d imagined. During my last set of surgical nights I was called to see a post op patient with a low blood pressure and a high temperature. I didn’t panic and start reeling off every cause, I simply assessed the patient.

Look at the obs chart, if your patient is awake take a brief history, run through the notes and admission clerking, make sure you know what’s going on with them and then you’ve usually got enough information to start with. The best way to approach is ABC and write in the notes this way too – it’s harder to miss things.

Honestly, the most fun you’ll have as a house officer (in work at least!) is on call because you’ll make your own decisions – and they actually matter. Along with the terror comes excitement – you’re on the edge – when you don’t fall off it feels great. You just need to know when you’re wobbling and get help. Too often during day to day ward work you’ve got a senior on hand and you tend not to think for yourself. On day one that’s great – at month eight that can be a little frustrating. It’s nice to feel like you’ve been listened to and to succeed on your own.

You’ll also get very good, very quickly at presenting cases. You’ll start off first day presenting like you did in medical school – every last minute detail, basically a running commentary of your time with the patient. You’ll find your consultant losing interest about the time you’re telling him what the patient had for tea last night – if he’s like mine he’ll start scanning the ward for more interesting jaundiced people! They say that average attention span is 12 minutes – for consultants on a post take ward round it’s not much more than 12 seconds. Hit them with the important information and if they want more they’ll ask.

We’ve both enjoyed our first six months. There’ve been far more ups than downs. We’ve learnt a lot, matured a lot (well a bit at least!) and made some great friends.

The consolidation period for those that aren’t aware is a compulsory period with some universities during which you shadow the house officer that you will take over from. This usually takes place after finals but before graduation and aims to give you a grounding in your first job before you actually start. You’re devoid of responsibility and generally thinking about when you can go on holiday. As such you tend to skim through this process without really taking much on board other than where to walk to on the first day. I would however recommend trying to make the most of this period – it will help you in the first week. Having said that I actually managed to consolidate on the wrong ward! Welcome to NHS efficiency guys!