It’s now three months since I started my Consultant post. I’m still being asked by colleagues how it’s going and if I’ve settled in yet. These are really tough questions to answer. I think it’s going okay, but then that’s only my perception, I probably need some feedback from the very colleagues who are asking me the question to really know the answer. As for if I’ve settled in…. I feel welcome and part of the team. I feel as though I know where most of the day-to-day things I require are now, so that’s a definite improvement. However, I still have waves of feeling inadequate and know that I don’t know all the answers to all the questions that others ask, or that I ask of myself, but I also know that I am unlikely to ever know them all. I’ve not found that happy place where I’m comfortable with not knowing, as long as I know where to find the answers, yet but I guess that will come in time. So, do I feel settled yet? Probably not, but I do feel like I belong, and that must count for something.
There are two things I want to touch on from these past three months – time off and that first on call.
Before I took up post I’d negotiated having December off work. This was achieved by a combination of leave and the joy of working an annualised rota. I knew it might be the only opportunity I’d get to have such a long holiday over the festive period during my working life. I would heartily recommend anyone taking up a new post to organise some leave shortly after you’ve started. The time off enabled me to go to FRCEM graduation and couple it with a Christmassy break in London with the family; catch up with friends; attend festive events to my heart’s delight and essentially thoroughly enjoy myself, all in the safe knowledge that the month end would still come with a pay slip. It gave me balance to the stress of starting a new job, time to recover from the fatigue that comes with that stress and most importantly something to look forward to when things felt overwhelming. The only downside is willing up the motivation to come back to work after having so long off.
Our rota organiser has been incredibly kind to me since I started. Not only was I supernumerary for the whole of November and granted a long holiday in December, she also saved my first on-call until the end of January. This gave me as much time as possible to feel “ready” for it.
In terms of preparation, I didn’t do anything particularly exceptional. I checked with my mentor, the day the rota came out, if it would be okay to call him if “the sky fell in” during the on-call. Another Consultant told me nearer the time that they’d be available for me to call overnight if I needed to talk anything through with them. As the day got closer I felt a little apprehensive. Part of this was a genuine fear that I would sleep thorough any call after I’d left. I have been know to sleep through fire alarms and those old fashioned alarm clocks with bells and hammers, even when placed next to my ear.
Now, in normal circumstances I may have felt more nervous a few days before. However, we will never know, as I had perfectly timed flu like symptoms and was sent home from work by a fellow Consultant six days before. I spent three days on the sofa and returned the day before the on call for a non-clinical day. I still had essentially no voice at this stage, and so this abated any first on-call induced fear.
The day arrived. I couldn’t sleep through the night without waking up several times to cough my lungs up, so although I didn’t feel ill, I certainly didn’t feel well and was pretty worn out before the on-call started. I bumped into my mentor on the way in – who checked I was well enough to be there and gave me some advice on a leaving strategy so I wouldn’t end up there all night. It didn’t quite work as efficiently as planned, but without it I would have probably stayed much later, so not a bad starting point. The aforementioned Consultant who’d offered to be available hung around whilst I was handed over the department and provided words of encouragement. The evening Consultant who’d sent me home the week before eyed me suspiciously before conceding that I was probably just about well enough to be there, and then also offered, on their way out, that I could call them overnight if needed. I couldn’t have felt more supported.
It started off as a really nice shift. There were beds in the hospital and there was flow. We were well staffed. Resus was half empty and until about 9pm we had no high acuity patients. Then the standby’s came rolling in, and the ambulance numbers picked up. My evening and night nurses in charge were great. I have a plan I like to follow when space gets tight to keep a resus bed and a majors bed free in order to accommodate high acuity patients at little warning and to always have a space to see and assess corridor patients whilst maintaining dignity. We kept to plan. Things were ticking over. I had three middle grades on for the night. I could hardly have been luckier.
Then came the tricky bit. How do you know when it’s the “right” time to go home?
I knew I was fatigued and it was becoming harder to make decisions, but my middle grades were all with patients of their own and the juniors were flocking to me for advice on their patients. I knew I needed to preserve enough energy to be able to return at any point overnight should the need arise, but knowing that doesn’t make it any easier. I still felt like I was abandoning ship. Reflecting on it now, I’ve managed much more difficult nights as a reg, and I know the team on were capable of looking after the department. I know I could have left at least an hour before I did (if not earlier) and I also know that that last hour which I spend hovering around wondering if it was really okay to leave was one of the most inefficient hours of my career to date.
The response to this query on twitter has been great – it’s really comforting to know that experienced Consultants still have the dilemma of not knowing when the “right” time to leave is. Similarly the advice given on how to work out when you should leave is very useful and this thread from Jim Crawfurd is definitely worth a read:
Incidentally, the combination of waking up coughing and waking up in sheer panic to check my phone hadn’t rung meant I hardly slept a wink. The good news being I didn’t miss any calls, and in my sleep deprived state nobody was reliant on my ability to think. The post on-call lack of sleep induced headache was tremendous, but I’m glad that milestone is completed. Let’s see what the next few months have in store.