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Rural peer support: a reflection
  1. James Alexander Keitley
  1. Correspondence to Dr James Alexander Keitley, Respiratory Medicine, Royal United Hospitals Bath NHS Trust, Bath BA1 3NG, UK; james.k{at}

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The call came innocently enough. A young child had fallen, reportedly suffered some bruising and potentially needed some pain relief. This brief did not prepare me for a child periarrest following major trauma. They had multiple fractures, widespread internal haemorrhage and several other injuries. Tragically, the story of motor vehicle accident was thought to be a concealment of non-accidental injury. This, on the night following my last official day of medical school.

In a rural island hospital, the out-of-hours staffing composed of one nurse, up to two medical students and two generalist junior doctors on-call 24/7. No surgery; no specialists; no scans.

It felt unreal—like another simulation. Yet this one was messy, chaotic and traumatic. Afterwards I sat on the floor and cried. The next day it felt wrong to leave the hospital, wrong to see people continuing on with life as normal, wrong to hear jokes and laughing on the ward. I could not face consultations with patients with minor health complaints, yet as an NHS doctor I would have needed to do so almost immediately following the event. I had been in …

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  • Contributors JAK: the inception, production and finalisation of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Author note JAK is a Foundation Year 1 doctor at Royal United Hospitals Bath, UK. He was studying medicine at the University of Manchester at the time of the events described.

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