Tuesday 12 February 2013

Black Wednesday

“77 year old female, everything is fine.....no wait.....she’s dead”

The first wednesday in August each year is known as Black Wednesday and so begins the ‘killing season’. It is the day that junior doctors start working in a hospital. It is also when a lot of other doctors change job role and as such, this day results in a significant increase in mortality of emergency patients. It is fair to say that Black Wednesday and the two days that follow are the worst days to fall gravely ill in the NHS. Saying that, is there ever a good one?! Up to 7000 graduates enter the halls of their respective hospitals and with it, the sudden burden of responsibility of the lives of their patients. The death rate in these three days each year rises by 6%. 

I don’t blame the newbies for this, they are thrown in at the deep end, they are made to do operations and procedures on patients way beyond their capabilities. On top of that they end up working the graveyard shifts when there are little or no senior staff around. They are in charge of wards, departments and health and wellbeing of all patients inside them. Someone who has just passed their driving test drives off and starts learning how to drive, someone who passes their law exams then goes off to learn how to be a lawyer. These kids, and they are kids, have spent years with their heads buried in text books. Their only patient contact and bedside manner has been learnt from corpses so it’s no wonder the proverbial shit hits the fan. 

I’m all for a steep learning curve. In those situations you learn a lot. In most walks of life, when you are learning, the mistakes that are made, end up costing time and money. In health care, the mistakes that are made, end up costing lives. It was daunting the first time I was in an ambulance as a crew of two! I didn’t really have a clue what I was doing. I always had a safety net. Firstly, I was never alone, secondly I was always with someone better trained than me and finally, if the shit really did hit the fan we were never more than a short drive to a hospital where the grown up could take over! Junior doctors don’t always have that safety net. The buck stops with them and that added pressure probably has a lot to do with labeling of ‘killing season’.

Personality has a lot to do with it to. Becoming a doctor is very competitive and as such there are egos at play. When we have dealing with a junior doctor there are generally three types that we me. 
  • The Flapper: These newbies are terrified. They know their stuff but don’t show it! The pressure is all to much. They look around to everyone else for the answers and are yet to have any confidence in their abilities. They drop things and actually look scared. Their patients will likely die from their inaction.
  • The Ego: These ones think they have made it. They know all there is to know. They walk around looking the part, walking the walk and talking the talk. They won’t ask for help because let’s be honest, they don’t need it. They talk down to nurses and ambulance staff because they are a DOCTOR. They try to do to much over and above their ability. Then patients die. They are ignored by all and they slowly realise they are not god.
  • The Awkward: These guys have all the social skills of grizzly bear. They know their stuff, they were probably top of every class they have ever been in. The problem is, they have absolutely no people skills and no bedside manner. They will not spot a sick person because they won’t look at their patients. They will not talk to their patients because they don’t know how to. They just look at numbers.
All three will learn and all three will improve, however once an arrogant arse, always an arrogant arse in my experience. 

This year during Black Wednesday week the A & E was absolute chaos. We were coming and going every hour on the friday night with another puzzle for the newbies to solve, as was every other ambulance in the area. Although they didn’t take the handover I could see them looking as the double doors swung open, hopeful there was nothing majorly wrong with them. At about 3am, we’d handed over our patient to the nurse, my crewmate was booking them in and I was changing the sheet on the bed. Suddenly, in a cubicle a few feet away there was a commotion. A junior doctor was in there with a patient and her son. 

“What do you mean she’s dead?”


“You said 3 hours ago that she was fine.”

“I know”

“You said she was asleep.”

“I know”

“How can you not know she was dead?”



I left the department so as to avoid the furore. Ah.....Killing Season, and so it begins with a key lesson......check your patient is breathing at regular intervals and ensure the monitoring equipment you have connected them to is switched on!


  1. Love it..as usual. My niece is a junior doctor and arrogant doesn't cover it. It's the stethoscope round the neck that does it!!!

  2. The best junior doctor I've come across for a long time turned out to be an ex paramedic.......

  3. hahaha oh god this is so true! even on the phone you can spot those archetypes! Of course there are the good ones who are sweet and listen and actually understand what they're doing. They're the rare breed...


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