First night

January 17, 2019 Brian Allain

First night

My first intern shift in emergency, the consultant smirked pleasantly at me. “Don’t be nervous” she said, “Just remember – the air goes in and out and the blood goes round and round.”


That is only half true. That’s what happens if you are a senior doctor. If you are an intern the referrals go in and out and the chronic pains go round and round. If you are an intern you spend more time fighting with the surgical registrar, arguing with the medical registrar, receiving barbs of criticism from the ICU registrar and being scared to call the gynae registrar than you do making blood go round and round.

It turned out, I should have been nervous. By some piece of creative rostering genius, my first time on the ED floor was a night shift on the Easter long weekend. The smirking consultant went home. The registrar smiled encouragingly. “Just call me if you are worried about a patient.”


Two minutes later I was standing gawkishly in front of her. “I’m worried about a patient.” She managed to not roll her eyes and accompanied me to the bed of a semi-anxious, semi-conscious man whose inefficient breathing seemed to be turning him a strange shade of bluish grey. The numbers were red and beepy. Even I knew red and beepy.


“We might get him on some Bipap, shall we…?” she said, in that reasonable, calm, slightly high-pitched voice. An hour later the functional eighteen percent of the patient’s lungs was being ventilated in ICU, and I was standing in front of the registrar again saying, “I’m worried about a patient.” She laughed grimly and followed me to triage where a six year old with Type I diabetes was impersonating a piece of cooked spaghetti trying to stand up.


I don’t remember much else of that night. An inexorable tiredness comes from straining to make an inexperienced brain work through the night, with foreign tools and people, and terror swirling around chest height most of the time. Like being sucked down a river of white water, holding on to a single kid’s floatie while the people around you are in sturdy rafts. In a team.


There was a gentle interlude sewing a drunk someone’s lip back together in the procedure room. Pull up the stool, switch on the light, prepare the tools and place the drape over the patient’s face. Because it was his lip, he couldn’t talk, though he tried. Quiet, load needle, forceps, take a piece, draw through, reverse needle holder, tie, cut, clang of scissors on the tray, admire, sigh, load needle, quiet.


The morning came. How strange it was, noticing that the visible strip of sky through the window above the resus area had turned from black to grey. The first beam of sunlight hit the handover desk and I understood that it was always going to come to an end, sometime.


“There’s a DOA outside.”

“The intern can do it, I’ve got a million things before handover.”


I went out onto the driveway. I will always remember the brightness of that central Australian sun, it seared my foggy brain. I was drunk with tiredness, like a teenage apprentice just worked their first full-time week. I was paranoid, like I was high and everyone knew it but me.


“He was found today, but hung himself probably a week ago.”


A boot opened, a bag was unzipped. A young Aboriginal man’s eyes did not look like eyes anymore. The funeral director looked at me impassively. He knows I’m high. I went through the ridiculous motions, and walked inside, out of that hideously bright sun, to fill out my first death certificate.