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A life saved by cramming

In my final year at medical school I shared a house with two other medical students. In the run-up to finals, we would quiz each other in the evenings. One evening I was asked about the antidotes for overdoses of various medications.

I worked my way through morphine, paracetamol and iron. Finally, my housemate asked me about benzodiazepines. I couldn’t remember the answer, and he ribbed me that there was no way I would ever get through the exams.

Fast forward six months: I’d passed my exams, and I was the foundation 1 doctor looking after a middle aged lady with biliary colic. She was a keen golfer, and between bouts of abdominal pain would enjoy telling me about her handicap and recent competitions. As her pain was not settling, she had an ERCP, under sedation.

A few hours after the procedure, I was fast bleeped to review her. She had returned with a reduced Glasgow coma score and a low respiratory rate, and the nurse looking after her was concerned. 

I suddenly remembered how gleeful my housemate had been when I didn’t know the answer to his question, and how I’d looked it up in the BNF that evening.

‘Flumazenil!’ I called out triumphantly to the nurses. I felt slightly less triumphant when they told me that only doctors could administer it, and handed me the vial and a syringe. I hadn’t even seen it given before, let alone done it, so I followed the instructions in the BNF carefully. 

‘Intravenous injection over 15 seconds.’

With shaking hands, I slowly injected it into her cannula, with miraculous effect. Within a minute she sat up and looked at me cheerfully.

‘Aren’t you the chap who was asking me about my golf?’ she asked. However, after three minutes she drifted off again.

Looking further down the indication and dose section, I read: ‘Repeat at one-minute intervals if required.’

I obediently complied, to good effect, and found out more about the latest local tournament. In short instalments.

I am happy to say that my patient’s abdominal pain settled, and she returned to her golf. And now I feel less resentful about cramming for exams. Sometimes, it does come in handy.

Thomas Williams is a specialty trainee 2 in paediatrics in Scotland

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