When I started as an FiY1, few things made me more uneasy than carrying the phone. Giving my number to the ward team at the start of an evening on call filled me with a sense of dread. I knew that if I got called about anyone who was acutely unwell, I would be able to escalate it to a senior who would swiftly come to my rescue. But I couldn’t help the feeling of the weight of responsibility.
Having just finished inserting a cannula, I headed off to grab some food. About a minute after leaving the ward, my phone rang.
“Hello, I know you’ve just left, but would you mind prescribing some analgesia for Mrs X? She’s allowed morphine every 4 hours but I don’t think she can wait that long.”
In medical school, we covered the WHO pain ladder multiple times, so I reckoned I could manage this.
Time to implement the plan
I saw that she’d had some paracetamol – check. Next morphine dose was due in… 20 minutes. Perfect, problem solved. But a second look at the chart showed me that the morphine was prescribed as a “PRN” medication and she had been taking it regularly since the late morning. I entered into the room to find someone unmistakably in pain. Then she practically recited a text book description: “the pain started in the middle of my tummy but now it’s just on the right”.
With strong suspicions of what I would find, I asked if she’d let me examine her. Nothing, nothing, nothing, nothing, slight tenderness…ARGH!!! She almost jumped as my fingers probed the right iliac fossa. For a strange moment, I was in an OSCE , fully prepared to give the management plan details to the examiner. Then I remembered that it was now my job to implement the plan.
From foe to friend
Before my heart could sink too far, I remembered something else – an SHO was always on the other end of a phone. That’s when my perspective began to change. The phone in my pocket was now a life line, and there was no limit on how many times I could phone a friend.