4 Stressful Experiences in Medicine and the One That Finally Makes You Leave General Practice

When I went into medicine, I did so as a mature student. Not a naive 17yr old straight of college with no idea how to use an iron or poach an egg, but someone with a hint of life-experience, a degree of weariness from years in a corporate job, and children. I thought I knew what was in store: heart-breaking conversations, gruelling hours, routine hierarchical humiliation and more exposure to the tough side of life than most ever see. And to a point, I was right. But what I didn’t see coming was the hidden stress, the parts of the job that really wear you down and the things that finally start to spell the end.

“I promise you. You’re going to be ok. You’ll be able to tell him yourself. We just need to get some fluids going and get this catheter in. I promise, we’ll get you sorted.”

My first experience of sepsis and the rapid and devastating path it can take - especially in seemingly young, fit people. It seemed so benign. A man in his forties. A urine infection that just hadn’t gone away. And now, a week later his temperature was spiking 40 and his heart rate was up above 100. He was completely lucid and talking to me as we stuck ECG pads to his chest, took blood samples from wrist and groin, ran his fluids wide-open and bleeped ITU. To the untrained eye - as mine retrospectively still was - it all seemed a bit excessive. But the A&E Reg knew how this would go. Temp first, heart rate next, followed by a crashing BP, a drop in GCS and then, in a relative blink-of-eye, he was tubed and ventilated. I had just promised him he’d be fine. I wrong. He wasn’t fine.

I still remember his army-green combat shorts, his brown eyes and the misplaced promise I made.

An awful night in resus? Yes. One that made me think this job wasn’t for me? No.

Arrived at work in the dark again. Night five of ten as the SHO (junior doctor) covering the wards of a busy, dilapidated teaching hospital. First stop - the handover briefing. Intended to improve patient safety by encouraging a thorough and complete handover of patients from the day team to the night team. Highlighting those who might present a challenge at 2am, as well any that were not expected to make it to morning. In reality it was a meeting where most of the time was spent redistributing resources in an attempt to make sure all areas were covered. Not unusually, there were people missing. I say that like nobody knew they wouldn’t be there, but these gaps in the rota were totally normal. Gap number one - the Medical Registrar covering A&E. According the almost-fictional rota, the Medical Reg is the most senior medical doctor in the hospital at night. And they weren’t here. Everyone moves along a seat and picks up an extra bleed as they go. The ward registrar was now the A&E registrar. The ward SHO was now the ward registrar - that would be me then. No-one more junior than me to take over my bleep, leaving me with two. One I was qualified for… and one I wasn’t.

A stressful night in the gloom of the hospital juggling one job I was barely surviving combined with a new role I had no business doing? Yes. One that made me think medicine wasn’t for me? No.

Fast-forward a decade and I’d made the move to primary care as a GP in a surgery just a few miles from home. No evenings. No weekends. Long hours? Sometimes. A disproportionate level of paperwork for the medical input? Certainly. Emergency situations in a clinical setting ill-equipped to deal with them? Occasionally.

There are few scenarios that send a shudder through a doctor’s whole being like a blue baby. In a hospital, surrounded by paediatricians, a skilled anaesthetist just a bleep away and all the kit you need - it’s a harrowing experience. Transpose that blue baby situation to your consulting room in GP-land, where all you have to hand is oxygen with a mask big enough to put the whole child’s head in it presents a whole new level of terrifying. You’re basically as helpless as the distraught parent who bought them in, except you’ve developed an almost inhuman way of just dealing with what’s thrown at you in the moment, and only crumbling in a heap once the paramedics have swooped in and you’re left sitting in a quiet corner of the staff room with a very sugary cup of tea. Billy, only eight weeks old and tiny even for his age, was floppy and grey. By the time I’d lifted him out his mother’s arms and laid him on the examination couch try and work out what was wrong, he was floppy and blue. This was not an improvement. The ambulance was already on its way and they were sending an advanced paramedic car ahead of them to help. A colleague held the oxygen to his tiny chubby cheeks while I placed my stethoscope on his chest. I closed my eyes. Partly by way of a small prayer to Gods I don’t routinely believe in, and partly to help me tune in to what was a frighteningly slow heart beat. A babies heartbeat is usually too fast to count. This was very countable and running well below my own. A sign that often signal an impending cardiac arrest. I took a deep breath - buying time while I ran through the paediatric CPR procedure in my head. As I opened my eyes, the paramedics were walking in. Laden with expertise and kit and miracles. Both Billy and I had survived, and now Billy had all the right people to get him sorted.

A situation that has you vomiting into a waste paper bin after the crew and the patient have left the building? Yes. An experience that made me want to jump into my car mid-clinic, drive away and never come back? No.

So if you can handle all this, what on earth would make you start to think - the end is nigh?

The next part is the surprising truth about what really makes me think “Have I had enough?”