Oh God. Okay so I just finished my first week of general surgery.
That was NOT fun. My word of the week was “chaos”.
Day 1 faced with 30 patients, all of them unwell and complicated.
General surgical ward rounds are like normal ward rounds on steroids. Everyone just gets a hi and a bye. The consultant and registrar walks in, greets them, says a two-word plan to no one in particular, and walk out. Me and my friend, the house officers desperately scrambling to write notes, check bloods, ask questions and just try to orient ourselves in the chaos.
What bothered me most was the lack of medical knowledge of the senior staff on my team. One of the patients had a blood potassium level of 2.2 (normal range 3.5-5.2).
Just coming off cardiology, this was a major alarm bell for me. I told my registrar I would give the patient IV potassium and orals, as well as do an ECG and repeat blood tests that afternoon to ensure it was increasing.
My registrar replied “you don’t need to repeat the bloods in the afternoon. Just repeat them the next day. Don’t worry about orals. Just give IV. ECG not a priority”
My cardiology soul was screaming on the inside. Every medical registrar I told this story to, screamed in unison that I should NOT listen to my registrar.
And I didn’t. I repeated the bloods in the afternoon and found it was NOT in fact increasing very much following 2 bags of IV potassium. I had to hose this patient down with orals and IV fluids overnight until it normalised 2 days later.
The registrars couldn’t care less.
And that really annoyed me. Coming from such a supportive environment on medicine, it was hard to work with people who can only perform miracles in a theatre. And outside of it, do very little for the patient.
This isn’t to say they’re useless or bad doctors. I have mad respect for surgeons. But their medical knowledge is just shocking. And all the house officers have just started being doctors. I felt more concerned and nervous every night this week than I had in the last 9 months, wondering if I had made the right decision for patients in my care.
I also do not know all 40 of my patients (yep it increased by day 3 to an even bigger number) simply because I don’t have the time I had on medicine to learn about their history and provide the care they need. When I have to refer to other specialties, I am ashamed that I don’t know the information they need to be able to help me and my patient. But I simply don’t have the time to look through one patient’s notes while the other 39 also need my attention.
This was a shocking glimpse of what the next 12 weeks will be like.
But the bright side is that I have friends who are immensely helpful. When me and my friend were drowning in work, a bunch of the other less busy house officers took on some of our jobs and that really helped. Without them, we would have finished later than a long day finish.
Complaining to a bunch of the other house officers who also came off medical runs, really helps. We’re all holding and helping each other out. And that is super important.
But I’m also becoming quite unhealthy in this last week. Starting at 0630 means no time for breakfast. Rounding until 1230 means late lunch and leaving super late means starving until dinner around 2030. I have felt weak and washed out this whole week too.
I really must remember to take care of myself.
Hoping the next 12 weeks go by really quickly