"Quick, get a CT abdo-pelvis for this newly admitted patient to rule out appendicitis", my on-call registrar ordered.

It was my very first call. While I had requested for CT scans before as a sub-intern in my 4th year, this was different. No longer was I a medical student, which meant that the radiologist on call was going to be a lot less forgiving.

With a sense of trepidation, I tried to find out as much as I could about the patient before I called the on-call radiologist. Upon whom I 'vomited' the entire deluge of the patient's presenting history and physical examination before getting to the indication for the scan.

"Why do you need an urgent CT scan? Isn't appendicitis a clinical diagnosis?", said an impatient and withering voice at the other end.

"Err... Because based on the clinical history and physical exam, my registrar thinks it is acute appendicitis." I replied meekly.

"Well if your registrar is pretty certain its appendicitis then shouldn't the patient be on the operating table?"

I was stumped by the rhetorical question posed by the annoyed but also tired and stressed out on-call radiologist. Although over that year I eventually learnt how to tickle the radiologist into granting a similar scan for my patient, I suspect my experience that night paid off because of my persistent and pitiful begging.

Fortunately, while this was the first of my many encounters with the on-call radiologist, it wasn't representative of most of my exchanges which were generally more cordial. It was also a good thing that this encounter didn't deter me from choosing to specialize in radiology. And while you may suspect it, I did not choose radiology so that I could strike fear in inexperienced interns.

It wasn't long before I was required to do first line calls, taking on a similar role as the on-call registrar, during my recent rotation to KKH. Only when one is placed in a similar situation of great responsibility does one finally understand how the on-call radiologist must have felt when he received my call. Was the scan necessary? Why is the doctor calling, wasting time and not getting to the point?

An ultrasound scan, when ordered on call at KKH, is performed by the on-call radiologist (aka me). Depending on the complexity, each scan may take anything from about 30 minutes to one hour. It turns out that there are a number of potentially life-threatening emergencies that may happen on call, such as a ruptured ectopic pregnancy. One does not want to be caught in a situation where an emergent case is delayed because of another non-urgent case. The onus is on us to triage and prioritize the requests; hence we reject scans that are not justified or non-urgent. Failing to do so compromises the safety of our patients.

Armed with these experiences, I now teach the Duke-NUS students who spend 1 week of their Year 2 curriculum in radiology. In particular (no prizes for guessing), part of what we teach is on how to request for scans from the on-call radiologist. Hopefully with practice requesting for scans from the radiologist as students, it will eventually make for a better night call for both the intern and the unsuspecting on-call radiologist.

Recently, Bianca and I shared our experiences in Dr Thiru's PCY 2 course on "moral distress and ethical dilemmas" in medical education. During the session, it suddenly struck me how easy it is to forget that we were once students. As we gain more experience through our training and become proficient, it is easy to forget the incompetencies and uncertainties we had to navigate as uninitiated medical students at the wards or as a newly minted intern. Let us never forget that we were once also students.

Congratulations to my fellow alumni who have newly graduated as interns, become MOs and also to my classmates who have turned senior residents. I am sure that as we progress in our training, we will continue to strive to teach, nurture and mentor students in a safe learning environment.

Note to self: I will try to control my temper even if I'm having a terrible call. Keep calm.