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

4 Weeks Later

Well, surgery is officially over. And I am exhausted. 

It didn’t really get better. I was still doing ward jobs all day and staying late even though not much was being achieved.

I feel like I haven’t used my brain at all these past 4 weeks. And that’s annoying.

So I am relieved it’s over. But I am concerned for my future years as a house officer when I have to do surgical rotations. My own house officer on this rotation was flustered 90% of the time, and complaining 98% of the time about her job. She would stay later than me and achieve pretty much nothing as well. No patients discharged, scans and tests ordered but not carried out, and an endless amount of paperwork to do.

She also said she hasn’t used her diagnostic skills in the whole time she has been on this rotation. Sigh. Not looking forward to this in the coming years.

However!

I will say that my registrar and my consultants are amazingly nice people. One of my consultants, while I didn’t manage to see him a lot, he was more than happy to talk to me whenever I approached him, even if he were in a great rush. He was happy to do my report and my reference (all 3 required references done! Woohoo now I can relax).

My other consultant also offered to do any assessments I required for me, and thanked me multiple times for my hard work. Though I’m trying to figure out what exactly that was.

And my registrar was the loveliest person in the world who never got tired of answering questions, teaching, making jokes and just being supportive. 

While the overall rotation was tiring and annoying, I am so grateful to the people on the team for making it bearable. 

Now. Onto ED. Time to turn my brain back on!! 

Translation Please?

Well this is something that has bothered me throughout med school. But today it was at such a frustrating level that I just have to talk about it on here.

Today an elderly couple had presented to hospital to be admitted. The wife was to have a major abdominal surgery the following day (Whipple’s procedure). They were a Chinese couple who had been living in New Zealand for many years now. Unfortunately, neither of them knew any English.

It took One hour for the house officer (who luckily spoke Mandarin) to explain the details of the woman’s procedure, translating for the surgeons. Another hour to get her to consent for a research project she had the opportunity to be a part of, and another full hour to admit her medically to the ward with the anaesthetics team.

Why?

Two words. Language Barrier.

The woman was so flustered by the end of the multiple consults that she requested to back out of the research project because she was uncomfortable and nervous that she didn’t understand a lot of the jargon even though it was translated.

She was quite anxious about her procedure and couldn’t follow many of the details described to her during the consent for the actual procedure itself.

By the end of it, both the patient and the doctors left with quite a yucky feeling. Neither completely satisfied that they had achieved full comprehension.

Medicine is so difficult. I can appreciate that fully as a medical student. But oh my goodness it must be even harder for general people to understand things.

And then throw in a communication obstacle in. What are we supposed to do here??

Immigrants are great. Moving to a new country is an awesome idea. But I wish people would do so with the intention of learning the language of that country. Fair enough if English isn’t taught or spoken in your country. Just like Spanish or French isn’t spoken in mine. But if I were moving to France, there is no way in heck I would do so without attempting to learn the language.

But in medicine, I’ve come across many patients who require interpreters. And from those experiences, I can tell you that they do not make the process any better at all. There’s always gaps. There’s always compromises being made and questions going unanswered. You just don’t get the full picture.

Fair enough if you are new to the country and you don’t know the language. But I take issue with the people who have lived in this country for decades, working, owning retail businesses, etc. etc, and yet saying they don’t speak any English.

I don’t understand it. Do they only ever talk to their own people? Do they stay at home forever? How does it work?

But I do know that when it comes that they become unwell unfortunately, they get sub-optimal care purely because the doctors can’t understand them or vice versa.

It’s just not fair. The doctors would also feel quite frustrated and helpless, not being able to provide the best care for patients like this. But there’s just no way around the barrier.

I just think that people need to take responsibility and ensure they are safe and can communicate in situations like this. Like it’s not just with doctors. In an emergency situation, how would such a person call for help? There are no interpreters in an emergency. They could be in danger.

And don’t get me started on interpreters. It’s just way too hard to be on the same page with them as well.

Gah. Just frustrating.

A language barrier is just dangerous. I just think people need to realise that. 

Surgery Gives Me A Headache 

I don’t have the hands or the stomach for it. I don’t have the patience or the discipline for it. I just don’t have the drive and the attitude.

I’ve just started my 4 week rotation on general surgery!

Lucky for me, being a gastroenterology enthusiast, I was placed in the hepatobiliary and liver transplant surgical team! So naturally I expected to be super interested and learn heaps!

My first week has been far from that, unfortunately. 

Back in 4th year, we were given the opportunity to talk to patients, go to theatre and take part in surgeries, and be taught in tutorials by consultants.

As a 6th year, my duty is much like the house officer’s. I check blood tests, write discharge summaries, and write notes for ward rounds. I have little to no interaction with any consultants or patients. 

As I am part of a sub-specialty surgical team, there’s no need to make diagnoses. Patients admitted to my team already have a diagnosis and a planned management plan. So there’s not huge amounts of thinking involved. Which makes me sad.

And consultants are never around. Whenever they have a spare moment to check on their patients (this could be any time of the day), they buzz the house officer to come running to write notes on further management. This is usually after the initial morning ward round. Which means that the plan has been changed for the 6th time that day. 

It’s all very messy.

And the consultants aren’t exactly the most interactive. Which I can understand. Surgeons are busy people. They check on their patients in a record time of less than 5 minutes. Their place to shine is under the bright lights of the surgical theatre. 

But up on the wards, they wave ‘hi’ to the patients and the team and disappear in a puff of smoke.

This is a problem. And I’ll tell you why.

As part of that darn application for next year again, I need 3 references from my first 3 rotations of the year. Which means following general medicine and general practice, general surgery has to be my place to get my 3rd reference. Which means I need to have some face time with consultants enough for them to put in a good word for me.

Which is extremely self involved and to be honest I’m hating this process. Because I seem to be getting into the mentality of strategically sizing up every consultant I meet to see who would be nice enough to request a reference from and presenting myself in a certain way so they’d like me. Blech. 

I can’t wait until I get my last reference and I can go back to being normal again. 

But until then, how am I supposed to impress the consultant? No idea. 

I attended a couple of surgeries hoping to meet a consultant, but all week it’s been extremely complex surgeries where they were all crowded over the patient and I could neither see anything nor be noticed at all before I quietly slipped out.

Surgery isn’t awful. It’s just a bit mundane at the moment because of current role and the format of the teams in this hospital. 

Ahh what to do. 3 weeks to go! Hopefully it’ll get better