Unlike in most medical TV programmes I can safely say that my seniors are pretty lovely. Yes they can be snappy and sometimes intimidating without meaning to, but they all not only teach us but also chat with us.
The other day I was sitting I the mess and my boss asked me if I thought he'd made the right choice regarding a specific intervention with a patient now that we were a few months down the line.
I had one of those scary moments. Was I supposed to blindly say that my consultant made the right choice? Obviously that would be the "safe" option. Who am I a mere F1 to say that my vastly experienced consultant was in the wrong.
I paused and thought.
I actually didn't know. Would I have done the same thing? It makes me wish we had a medical time machine and that we could see all the possible different outcomes of our decisions. I'm sure with the benefit of hindsight there will always be time where we think that on balance our initial choices may not have been the best.
I said as much to my boss and he just nodded.
Later he gave me a great piece of advice.
Looking back with hindsight can be useful, but as long as you know you made a safe decision in the best interests of the patient that it doesn't matter if things don't always work out exactly as planned.
I hope I can remember that next time I'm thinking what if?
Dr Sunshine xXx
Monday, 26 March 2012
Tuesday, 13 March 2012
Surgical Week Day on Call.
People seem to like it when I go through what I actually do rather than rambling during a post. I've already covered what I do on a weekend on call, so I today you're going to get a blow-by-blow account of one of my weekdays on call...
07.53 - Arrive in the mess early enough for a cup of tea. Fluid balance, especially ones own, is the key to FY1 success.
08.04 - Moan about the lateness of the rest of the team and feel ranty. Spend the extra time trying to securely tape the battery into the on call bleep as it keeps falling out.
08.11 - Joined by the rest of the team for Ward Round. Traipse around the wards with my pile of blood results and scan results. Get the medical students to write in the notes while I keep a detailed list of jobs. This is the awesome thing about having medical students, it gives you extra hands to be more organised.
08.47 - Awkward bad joke moment where consultant tells patient they are being referred to gynae by explaining "I don't deal with ladies bits... at least not professionally". I actually snort in laughter. Patient looks mildly, but pleasantly confused.
09.50 - Still on ward round. Silently thank the gods of medicine that as this is surgery it's almost over.
10.07 - Quick cup of tea in the mess while splitting the jobs with the rest of the team. Have to reassure students that the ward round banter is the consultant liking them as opposed to bullying them. It really is him liking them... our team just has quite a harsh sense of humour. Have to constantly remind SHO that I'm on call as well as looking after the ward jobs so I don't get totally dumped on.
10.20 - Prioritise. This is an important buzz word. For morning job I prioritise as follows; If a patient is really really sick look after them first. Sounds silly and obvious but it's all to easy to leave a sick patient just to order a scan or write a quick discharge. I'm quite anal about getting the sick patients sorted before anything non-urgent is done. Lucky for me this morning all my patients are stable. So then the order in which I do things is firstly order all the scans I need. Secondly order all the bloods I need. Nicely ask the med students to bleed the patients. While they do that I refer all the patients who need other team input early in the day before they get too busy and chug through my discharge notifications. Once that's done I go and have a bash at any of the bloods/cannulae the medical students couldn't do.
All of our surgical house officers work as a team and if you don't have anything to do because your jobs get finished early we ask the people with more patients if they need a hand. Yesterday I had the most patients, but through a mixture of robotic like efficiency and a fantastic team we got it all done by lunch time.
12.30 - Had a look at what was on offer in the canteen. Looked like dog food warmed up. Went for a sandwich and some fruit instead. Getting something to eat while on call is also really important. By this point of the day I was a little worried that I hadn't fixed the on call bleep as it had been calm. Bleeped myself twice to be sure. It was working.
13.10 - Chased blood and scan results and generally pottered about. Did a little bit of OSCE teaching too to pass the time. Kept looking at the bleep wondering why it was so quiet.
15.27 - Realise steth is broken. Look devestated. Take my steth to see the surgical SpR who performed surgery. He did a bottomoftubingotomy and replaced the end. It works but is a little short. I was very grateful.
17.06 - Got a bleep. Got a bit peeved. Patient who had an Hb of 6.1 in the morning. Day team had written in notes that the patient was hard to cannulate and that they were organising a transfusion and getting the anaesthetist to cannulate. Firstly... why couldnt they have bleeped the day team who knew about it 7 minutes earlier when they were still working? Secondly why did noone from the day team hand this over? Had to go and properly assess the patient, cannulate and order blood to transfuse. At least this filled up some time.
17.55 - Just as I was finishing writing in the notes the trauma bleep goes off "Trauma call to a&e in 15 minutes..." Time to grab a quick glass of squash before heading to a&e.
18.15 - Lady fallen off horse arrives in a&e. Realise I am the most senior member of surgical team. SpR is in theatre and SHO isn't answering the bleep. Put in a cannula and thoroughly annoy the a&e SpR as my bleep goes off 8 times in the space of about 3 minutes. Escape to answer bleep. Get an ear bashing from SHO who wants to know where I am and why I'm not answering my bleep. Inform him "I'm at a trauma call in resus... where the hell are you?!" - Turns out his bleep actually isn't working.
18.20 - SHO turns up at trauma call. Patient is surgically OK but has broken a leg. Ortho takes over. SHO sends me up to paediatric ward to take some paediatric bloods and explain a scan result to a patient and their Mummy. Everyone knows how much I like paeds and how much the paeds ward likes me, so I often get this job. They have nice biscuits up there. Noms.
19.00 - Get bleeped by harassed looking SpR. He has lots of patients to review. Asked to come and help.
19.02 - Arrive in ITU to review patient who is "bleeding everywhere..." They have a small trickle of blood escaping their dressing and a really tiny little vessel that hasn't been cauterised. I make myself sterile and hold a piece of cotton wool on it for 5 minutes. This is my first (and probably last) surgical intervention as a doctor. It was a success. I feel unneccessarily pleased with myself. A 5 yr old could have done the same. SpR finds my self satisfaction amusing.
19.15 - Arrive on medical ward to see patient with upper GI bleed that can't be stopped with endoscopy. They are stable which is good but the SHO from their team can't get blood, which is bad. They're just about to go for a femoral stab when I see a big juicy wrist vein. I get blood from that vein. Feeling rather pleased with myself again. It's not often that things go that well for me repeatedly over the day.
19.45 - Run to a&e to help snowed under SHO chase bloods on the patients he's seen, do 2 ABGs and write the list for handover...
20.25 - Print list for handover, make well deserved cup of tea.
20.31 - Bleep goes off in handover. SHO steals bleep and throws the battery away. He's very strict about finishing on call on time. I sneak away to answer the bleep. No need... bleeped by mistake.
20.45 - Handover done. Time for home... remarkably on time for an on call!
Dr Sunshine xXx
07.53 - Arrive in the mess early enough for a cup of tea. Fluid balance, especially ones own, is the key to FY1 success.
08.04 - Moan about the lateness of the rest of the team and feel ranty. Spend the extra time trying to securely tape the battery into the on call bleep as it keeps falling out.
08.11 - Joined by the rest of the team for Ward Round. Traipse around the wards with my pile of blood results and scan results. Get the medical students to write in the notes while I keep a detailed list of jobs. This is the awesome thing about having medical students, it gives you extra hands to be more organised.
08.47 - Awkward bad joke moment where consultant tells patient they are being referred to gynae by explaining "I don't deal with ladies bits... at least not professionally". I actually snort in laughter. Patient looks mildly, but pleasantly confused.
09.50 - Still on ward round. Silently thank the gods of medicine that as this is surgery it's almost over.
10.07 - Quick cup of tea in the mess while splitting the jobs with the rest of the team. Have to reassure students that the ward round banter is the consultant liking them as opposed to bullying them. It really is him liking them... our team just has quite a harsh sense of humour. Have to constantly remind SHO that I'm on call as well as looking after the ward jobs so I don't get totally dumped on.
10.20 - Prioritise. This is an important buzz word. For morning job I prioritise as follows; If a patient is really really sick look after them first. Sounds silly and obvious but it's all to easy to leave a sick patient just to order a scan or write a quick discharge. I'm quite anal about getting the sick patients sorted before anything non-urgent is done. Lucky for me this morning all my patients are stable. So then the order in which I do things is firstly order all the scans I need. Secondly order all the bloods I need. Nicely ask the med students to bleed the patients. While they do that I refer all the patients who need other team input early in the day before they get too busy and chug through my discharge notifications. Once that's done I go and have a bash at any of the bloods/cannulae the medical students couldn't do.
All of our surgical house officers work as a team and if you don't have anything to do because your jobs get finished early we ask the people with more patients if they need a hand. Yesterday I had the most patients, but through a mixture of robotic like efficiency and a fantastic team we got it all done by lunch time.
12.30 - Had a look at what was on offer in the canteen. Looked like dog food warmed up. Went for a sandwich and some fruit instead. Getting something to eat while on call is also really important. By this point of the day I was a little worried that I hadn't fixed the on call bleep as it had been calm. Bleeped myself twice to be sure. It was working.
13.10 - Chased blood and scan results and generally pottered about. Did a little bit of OSCE teaching too to pass the time. Kept looking at the bleep wondering why it was so quiet.
15.27 - Realise steth is broken. Look devestated. Take my steth to see the surgical SpR who performed surgery. He did a bottomoftubingotomy and replaced the end. It works but is a little short. I was very grateful.
17.06 - Got a bleep. Got a bit peeved. Patient who had an Hb of 6.1 in the morning. Day team had written in notes that the patient was hard to cannulate and that they were organising a transfusion and getting the anaesthetist to cannulate. Firstly... why couldnt they have bleeped the day team who knew about it 7 minutes earlier when they were still working? Secondly why did noone from the day team hand this over? Had to go and properly assess the patient, cannulate and order blood to transfuse. At least this filled up some time.
17.55 - Just as I was finishing writing in the notes the trauma bleep goes off "Trauma call to a&e in 15 minutes..." Time to grab a quick glass of squash before heading to a&e.
18.15 - Lady fallen off horse arrives in a&e. Realise I am the most senior member of surgical team. SpR is in theatre and SHO isn't answering the bleep. Put in a cannula and thoroughly annoy the a&e SpR as my bleep goes off 8 times in the space of about 3 minutes. Escape to answer bleep. Get an ear bashing from SHO who wants to know where I am and why I'm not answering my bleep. Inform him "I'm at a trauma call in resus... where the hell are you?!" - Turns out his bleep actually isn't working.
18.20 - SHO turns up at trauma call. Patient is surgically OK but has broken a leg. Ortho takes over. SHO sends me up to paediatric ward to take some paediatric bloods and explain a scan result to a patient and their Mummy. Everyone knows how much I like paeds and how much the paeds ward likes me, so I often get this job. They have nice biscuits up there. Noms.
19.00 - Get bleeped by harassed looking SpR. He has lots of patients to review. Asked to come and help.
19.02 - Arrive in ITU to review patient who is "bleeding everywhere..." They have a small trickle of blood escaping their dressing and a really tiny little vessel that hasn't been cauterised. I make myself sterile and hold a piece of cotton wool on it for 5 minutes. This is my first (and probably last) surgical intervention as a doctor. It was a success. I feel unneccessarily pleased with myself. A 5 yr old could have done the same. SpR finds my self satisfaction amusing.
19.15 - Arrive on medical ward to see patient with upper GI bleed that can't be stopped with endoscopy. They are stable which is good but the SHO from their team can't get blood, which is bad. They're just about to go for a femoral stab when I see a big juicy wrist vein. I get blood from that vein. Feeling rather pleased with myself again. It's not often that things go that well for me repeatedly over the day.
19.45 - Run to a&e to help snowed under SHO chase bloods on the patients he's seen, do 2 ABGs and write the list for handover...
20.25 - Print list for handover, make well deserved cup of tea.
20.31 - Bleep goes off in handover. SHO steals bleep and throws the battery away. He's very strict about finishing on call on time. I sneak away to answer the bleep. No need... bleeped by mistake.
20.45 - Handover done. Time for home... remarkably on time for an on call!
Dr Sunshine xXx
Sunday, 11 March 2012
Weekend Guilt
Part of this could be because I'm Catholic (and we're trained to feel guilty about EVERYTHING), but at this time on the weekend I'm always overwhelmed with guilt.
Guilt that I've not tidied, guilt that I've not ironed, guilt from lack of ePortfolio work and lack of revision guilt. I also have too much yummy food guilt and quite often post-cocktail guilt.
I'm now torn with putting away my washing, washing my hair and then doing an hour of eportfolio before bed, or throwing caution to the wind and watching the new Disney DVD I bought over the weekend. I am so rock 'n roll.
This week is going to be a toughie with 3 on calls and 3 days post-take (including post-take from the weekend tomorrow). For those of you who don't know the terminology post-take is the day after the team has been on call, where we have to see ALL the new patients and make sure they all have good management plans. After the weekend this can be actually insane.
Lucky for me I have two rather lovely, clever and pretty medical students. Not only does this mean they should be good to work with as they seem to have common sense and want to learn stuff, but the fact they are pretty means that they might be able to sweet talk radiology into scans and porters into getting the patients there for the scans. Fingers crossed.
Although the my week ends with a Friday evening on call I then have a 3 day weekend (hurrah for annual leave). This is the first St Patrick's day that I'm not working and I'm old enough to drink, so I shall be celebrating my socks off... starting with watching the rugby and then seeing where the day takes us.
Before then I have (another) presentation to do, as well as all the on calls and post-takes and to top it all off one of the consultants wants me to write a letter to the NEJM about the criticisms we have for a paper I reviewd in journal club. Not too sure how well these criticisms will go down from an FY1...
Dr Sunshine xXx
Guilt that I've not tidied, guilt that I've not ironed, guilt from lack of ePortfolio work and lack of revision guilt. I also have too much yummy food guilt and quite often post-cocktail guilt.
I'm now torn with putting away my washing, washing my hair and then doing an hour of eportfolio before bed, or throwing caution to the wind and watching the new Disney DVD I bought over the weekend. I am so rock 'n roll.
This week is going to be a toughie with 3 on calls and 3 days post-take (including post-take from the weekend tomorrow). For those of you who don't know the terminology post-take is the day after the team has been on call, where we have to see ALL the new patients and make sure they all have good management plans. After the weekend this can be actually insane.
Lucky for me I have two rather lovely, clever and pretty medical students. Not only does this mean they should be good to work with as they seem to have common sense and want to learn stuff, but the fact they are pretty means that they might be able to sweet talk radiology into scans and porters into getting the patients there for the scans. Fingers crossed.
Although the my week ends with a Friday evening on call I then have a 3 day weekend (hurrah for annual leave). This is the first St Patrick's day that I'm not working and I'm old enough to drink, so I shall be celebrating my socks off... starting with watching the rugby and then seeing where the day takes us.
Before then I have (another) presentation to do, as well as all the on calls and post-takes and to top it all off one of the consultants wants me to write a letter to the NEJM about the criticisms we have for a paper I reviewd in journal club. Not too sure how well these criticisms will go down from an FY1...
Dr Sunshine xXx
Thursday, 8 March 2012
Awkward!
A weird thing happened to me the other day. One of those things that I should have guessed would happen since I work so close to where I grew up.
I bumped into an ex boyfriend in town who said "Oh, you were the doctor who looked after my housemate when he had his surgery last week."
I had been so busy blustering about that even when I'd spoken to the guy I just hadn't placed him as someone I know through a friend. It also left me with one of those awkward confidentiality moments. I spent the week afterwards thinking to myself "Must not accidentally mention perianal abscesses..."
Feeling a bit relieved now. Just saw it posted all over Facebook that everyone knows that's what happened. The only thing I now have to feel awkward about in the pub is having seen his bum.
At least I didn't give him a PR like someone else I know.
I'll definitely be avoiding going to their house for a while.
Dr Sunshine xXx
I bumped into an ex boyfriend in town who said "Oh, you were the doctor who looked after my housemate when he had his surgery last week."
I had been so busy blustering about that even when I'd spoken to the guy I just hadn't placed him as someone I know through a friend. It also left me with one of those awkward confidentiality moments. I spent the week afterwards thinking to myself "Must not accidentally mention perianal abscesses..."
Feeling a bit relieved now. Just saw it posted all over Facebook that everyone knows that's what happened. The only thing I now have to feel awkward about in the pub is having seen his bum.
At least I didn't give him a PR like someone else I know.
I'll definitely be avoiding going to their house for a while.
Dr Sunshine xXx
Wednesday, 7 March 2012
Not Quite A Love Letter
Quite often I find it really hard to say what's on my mind, especially to people I care about. Although on the surface I seem eternally cheerful and full of confidence, like most people, that's not always entirely true.
At the moment there are a lot of things I want to say to my boyfriend but I can't. I'm afraid he'll think I'm silly, I'm vastly overreacting, I'm nuts or that quite simply I'm not for him.
A large part of me wants him to read this, but I feel like I can write it and share it with you guys pretty safe in the knowledge that he won't.
Dear Hairy-Man,
I don't want this to come across as an attack. I can't stand relationships where anyone thrives on making their loved one feel bad about themselves. That's why I'm going to start by telling you how much I appreciate the lovely things you do for me. I love the fact you text and call me everyday just to see how I am. I love how you send me flowers just because and how you travel all the way to my house and put up with my crazy extended family when you're exhausted after a holiday. It's great waking up curled up next to you and your cute sleepy grumpy face always makes me smile when I'm trying to wake you up.
Sometimes I get really stroppy with you and you don't understand why. Saturday was one of those days. Looking at it in perspective I should be over it by now, but I'm not. It just felt so awful to make an effort to look nice and then you didn't even want to dance with me but you were happy to dance with some (gorgeous) random girl. It felt like such a snub. I know it's selfish but I want to be the only girl you look at, I want to feel like I'm the most special, most fanciable, most lovely girl you know.
I pretend all the flirting with your female friends doesn't bother me, and when I do feel like you love me and you want me it doesn't bother me that much. When I don't feel as wanted it makes me feel sick in the pit of my stomach. It's probably paranoia but it's hard to think rationally when I feel so low about myself. Sometimes I just need a little reassurance.
I wish I could say all of this out loud to your face, or even that I would have the guts to email this to you but I won't. I don't want the confrontation. I don't want to face the fact that maybe some of the girls you flirt with are more special to you than I am.
Dr Sunshine xXx
At the moment there are a lot of things I want to say to my boyfriend but I can't. I'm afraid he'll think I'm silly, I'm vastly overreacting, I'm nuts or that quite simply I'm not for him.
A large part of me wants him to read this, but I feel like I can write it and share it with you guys pretty safe in the knowledge that he won't.
Dear Hairy-Man,
I don't want this to come across as an attack. I can't stand relationships where anyone thrives on making their loved one feel bad about themselves. That's why I'm going to start by telling you how much I appreciate the lovely things you do for me. I love the fact you text and call me everyday just to see how I am. I love how you send me flowers just because and how you travel all the way to my house and put up with my crazy extended family when you're exhausted after a holiday. It's great waking up curled up next to you and your cute sleepy grumpy face always makes me smile when I'm trying to wake you up.
Sometimes I get really stroppy with you and you don't understand why. Saturday was one of those days. Looking at it in perspective I should be over it by now, but I'm not. It just felt so awful to make an effort to look nice and then you didn't even want to dance with me but you were happy to dance with some (gorgeous) random girl. It felt like such a snub. I know it's selfish but I want to be the only girl you look at, I want to feel like I'm the most special, most fanciable, most lovely girl you know.
I pretend all the flirting with your female friends doesn't bother me, and when I do feel like you love me and you want me it doesn't bother me that much. When I don't feel as wanted it makes me feel sick in the pit of my stomach. It's probably paranoia but it's hard to think rationally when I feel so low about myself. Sometimes I just need a little reassurance.
I wish I could say all of this out loud to your face, or even that I would have the guts to email this to you but I won't. I don't want the confrontation. I don't want to face the fact that maybe some of the girls you flirt with are more special to you than I am.
Dr Sunshine xXx
Tuesday, 6 March 2012
Buried Deep
As per usual it seems like I have so much to do and not enough hours in the day.
I just can never seem to say no when asked to do things and even now, snowed under as I feel, I'm still taking on yet more and more bits and bobs around the hospital.
This week alone I have to write a Journal Club presentation, write a mortality meeting presentation, finally get around to processing the data for audit 1, collect the data for audit 2, start planning the final year OSCE, do a mess shop, plan a mess dinner and find a new car.
I could also do with doing some washing, cleaning my bathroom and having dinner with my Dad at some point.
I shouldn't forget that I also have an actual job to do and revision for this dreaded exam in June.
So much for work being less busy than university...
I'm now at the point where I'm seriously looking forward to July as the student OSCE will be done, my exam will be done, my eportfolio will be done and I can just do my job and otherwise have fun. No doubt I'll find something else to take on.
I was wondering if anyone fancied being my PA for a few months?
Dr Sunshine xXx
I just can never seem to say no when asked to do things and even now, snowed under as I feel, I'm still taking on yet more and more bits and bobs around the hospital.
This week alone I have to write a Journal Club presentation, write a mortality meeting presentation, finally get around to processing the data for audit 1, collect the data for audit 2, start planning the final year OSCE, do a mess shop, plan a mess dinner and find a new car.
I could also do with doing some washing, cleaning my bathroom and having dinner with my Dad at some point.
I shouldn't forget that I also have an actual job to do and revision for this dreaded exam in June.
So much for work being less busy than university...
I'm now at the point where I'm seriously looking forward to July as the student OSCE will be done, my exam will be done, my eportfolio will be done and I can just do my job and otherwise have fun. No doubt I'll find something else to take on.
I was wondering if anyone fancied being my PA for a few months?
Dr Sunshine xXx
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