General Surgery Week 1

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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

Expected And Unexpected 

Life is full of the expected and unexpected. 

Like how unexpected it was that my registrar shared something so personal with me and it made me feel so great.

But then expecting a friend who has known me for years to understand my feelings, only to have that thrown in my face.

But then the same friend saying something I was absolutely not expecting and which continued to haunt me all day.

All the surgical house officers anxious and expecting the worst for tomorrow on the first day of general surgery. 

Sometimes it all becomes too much. 

I had to disappear. And reflect. And take photos.

Expectations are on the whole not a good thing. But having the unexpected happen to you isn’t always a good thing either. Being blind-sided is a weird feeling. 

But I can always expect the aesthetics of nature to take some of the edge off.

We’re A Team

Nearly done with my rotation on cardiology.

I have to say this has been my most favourite rotation so far. The hours have been long but the consultants have been fabulous and the work has been so interesting.

But the best part of this rotation is my amazing registrar.

Dr. Bradley is the most senior registrar at my hospital at the moment. He is currently the Chief resident.  9 years of experience on him, he is hilariously sarcastic, the best at being a cardiology registrar, and the most supportive colleague I have EVER had.

Without word of a lie, every other registrar I’ve seen or worked with has left me to finish the jobs and gone home at the end of the day in EVERY rotation I’ve ever had. And this hasn’t really bothered me much. Until the bar was raised.

Even if it’s 6:30pm and we’re tired and barely chugging through, and I’ve told him he should go home, Dr. Bradley says “We’re a team! I’m not leaving you behind!” and proceeds to stay there and wait until I’ve finished any remaining jobs and helps me with anything that needs doing.

The amount of difference that makes to the work experience is amazing. It made me want to work harder and be more efficient. Made coming to work that much better.

He even invests a lot in my learning. Teaching me how to do DC cardioversions, Treadmill tests and ward cardiology reviews by myself (reviewing patients referred by other teams to cardiology. This is usually a registrar job) and present to our consultants. He stands next to me and backs me up if the consultant asks something I don’t know. If any consultant or anyone at all tries to undermine me, he tells them I’m a future cardiology registrar and I can handle anything.

Having a senior colleague like that is so important. All of my previous registrars have been good and reasonable enough to work with. But none of them have really given me the responsibilities and support and trust that Dr. Bradley has. He makes my role seem very important to the team, even though I’m just a first year house officer and the bottom of the ladder compared to him and the rest of the team.

That’s what I will miss most about cardiology and why I’m so sad to move on to general surgery.

But I am so incredibly grateful to have met Dr. Bradley and have a role model that I aspire to be when I become a registrar.

A Stupid, Dumb, Bad Bad Week

I just finished a 10-day stretch at work and this has been the worst week I’ve had thus far in cardiology. 

I’m sure wherever you’re working you’ve dealt with people who micromanage. We all know someone like that. 

This week I had a consultant who was so pedantic, he micromanaged me all the way to misery.

New consultant, fairly young electrophysiology cardiologist in a permanent blue suit. 

He started off by telling me I have to show up an hour early and write up all the patient’s weights and blood tests before the ward round, but ends up checking them himself on the actual ward round.

He asks me to write long elaborate notes for him but then casts his eyes over them and says “do you mind if I rewrite that?”

He spends a lot of time sorting out his personal life in the middle of the ward round.

He tells me I HAVE to get something done TODAY but won’t let me leave the ward round briefly to organise said thing that HAS to be done TODAY, even though he has a registrar with him perfectly capable of taking over my tasks while I sort things out.

“Don’t split from the round” he says, “just do it when you get back afterwards”. Oh but here’s the catch, when we “get back afterwards” it’s 3pm and there’s no time to do any of the jobs because the consultant just spent 6h doing his ward round that he showed up late for.

Then after I had worked my hardest to organise the thing TODAY, he calls me up to say he’s already organised it and I just need to coordinate with some minor part of the operation to make sure it’s done. Why was I asked to do something you were able to do yourself??

Ugh.

It didn’t help that my usual registrar, (who I will talk about in a different post) was away this week. And the reliever had never done cardiology and hence had no idea what was going on.

He means well. He’s overall a nice person I suppose. But man, people who micromanage need to be aware of what they’re doing. And how unnecessary it is. 

It would’ve been fine if somehow we were more efficient, but we weren’t. I was staying way late to complete all my tasks and ward round was going on for ages

No other consultant had been like this. They had all let me do my job and we had been done with everything on time. 

Ugh. 

Well I’m glad this week is over.