Post 37 Inexperience leads to embarrassment!

The patient was a lad of about 19 years who was clearly drunk.  He was quite unable to give an account of himself but his mates said that he had fallen down some steps on his way home from one of the nightclubs in the city centre.

Inexperienced as I was, it was obvious from the gross deformity of his ankle that his ankle was broken and from my medical training I knew that an x-ray would be required to determine the nature and extent of his injury.  I also knew that the radiographer ‘on call’ would be tucked up in her bed somewhere in the nurse’s home. Nurses and female radiographers were locked up at night at a safe distance from the doctor’s residency!

Confident that I was following the correct procedure I rang her and apologised politely for disturbing her. I then explained about the lad with the ankle injury and invited her (with an appropriate ‘please’ and ‘thank you’ as becomes a lowly resident) to confirm my diagnosis. I remember one of the senior physicians advising that you should never ‘order’ an x-ray or a blood test; you should always ‘request’ one.

A long pause followed, so long in fact that I thought that in her sleepy state she had not understood what I had said.

I was just about to repeat my request when she spoke. Her aggressive tone alarmed me.

 “What the bloody hell do you expect me to do about it at this time of the night?”

“Well I thought it might be appropriate to get it x-rayed,” I said, recovering sufficiently to add a trace of sarcasm to my voice.

“And what would be the point of that?” she snapped back. “Are you going to be able to anaesthetise him whilst he is drunk? Do you suppose that the orthopaedic surgeons are going to reduce the fracture in the middle of the night?  Don’t they teach you anything at Medical School these days?

For god’s sake; immobilise it, relieve his pain and send him to the x-ray department in the morning.”

With a bang the telephone receiver went down.

My first response was to feel anger. I wasn’t responsible for the lad’s broken ankle. I had been perfectly polite to her, what right did she have to be so rude to me?

However, on reflection and having chatted things over with the nursing sister in charge of the department, I had to admit that she was quite right. Nothing would be gained from x-raying him at three in the morning.

Yet again I realised that whilst I had a great deal of medical knowledge, (well at least sufficient to pass the final medical school exam!) my training had left me inadequately prepared for the practicalities of medical life.

Further embarrassing experiences were to follow but they can be the subject of later posts.

Quotation for the day

Education is what you get if you read the small print

Experience is what you get if you don’t.                                                             Peter Seeger 1919-2014          American singer/songwriter  ‘Where have all the flowers gone’    



Extract from doctor’s letter : The patient has left her white blood cells at another hospital