My first time on call

BMJ 2007; 335 doi: (Published 19 July 2007) Cite this as: BMJ 2007;335:146
  1. Olaoluwatomi Lamikanra, medical officer, Baptist Medical Centre, Lagos, Nigeria
  1. t_lami{at}

    It was my first time on call, and I was to cover the emergency room from 4 pm until 8 am the next morning. The early part of my shift was uneventful, and I successfully cleared the minor cases of malaria, colds, and catarrhs. My great fear had long been of being accosted by a patient and not knowing what to do, so that night I retired to bed with hopes and prayers for a sweet sleep, dreaming of nothing related to medicine.

    My ordeal started at about 11 pm. The first inkling of trouble came from shouts at the hospital gate, which rapidly progressed to the emergency room. After a brief knock on my room door, a nurse's head appeared: “Doctor, we have accident victims,” she said.

    I stepped rather timidly into the emergency room to find it full of passengers from a bus. I could see only one potential patient, a man clutching his chest and making a lot of noise, while the other people added to the increasing bedlam. To make matters worse, the National Electric Power Authority had decided that working in pitch darkness was preferable to having light, so I had the extra burden of examining a possibly seriously injured patient by lantern light.

    My worst fears had not just materialised, they had multiplied. I was so confused. I am sure the people in that room smelt my fear and indecision. “Nurse, nurse where is the doctor?” (This was to my memory the only time I denied my profession.)

    “He is coming,” I replied, for in that moment I suddenly remembered there was a second doctor on call, the registrar. I immediately told the orderlies to run to call him, and, as an extra measure, I sent the ambulance driver too.

    Meanwhile, I tried to make the patient comfortable; he did not assist me but proceeded to shout with increased vigour that he was going to die. The minutes before the registrar arrived seemed like hours; “Where is he? Oh, where is he?” I continued to lament.

    Suddenly he appeared. Looking at my face and then around the room, he summed up the situation. The first thing he did was to send everyone except the patient and one other passenger out of the room to make more space and reduce the chaos. Then, very calmly, he said, “Dr Lamikanra, ABC of resuscitation.”

    Immediately I felt so stupid. How had I forgotten the most basic facts? In a few minutes the examination was over, and the patient who had been about to die had calmed down considerably.

    I finished my shift the next morning knowing that, even if you have forgotten everything, starting from the basics is always the best thing to do.

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