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


  1. Get you all growed up n stuff! Well done. Savour those moments. Did you talk to anyone? Did you make ANY time for your self? Did you eat in the evening?

  2. Had a tuna sandwich when I got home, but a sneaky choccie biccie in handover. Lucky for me my on calls are filled with banter and ranting so that makes them pass much easier.

  3. Sounds like a fantastic day! I hope I get there one day! :)