Learning to Except the Chaos

So here I am – three weeks into being a doctor. I have not yet been struck off from the General Medical Council Register, been hit by a patient, or been reprimanded by my seniors. All in all then, a good week.

This week I was covering another speciality in surgery, which meant I left the comforts of known faces and routines built up over the past two weeks that helped like a 2 year olds security blanket in the dead of night, and stepped into an unknown world. And was it a busy world!

The team I joined focuses on bladder and kidney issues. What does that mean for me, as the most junior doctor of the team?…lots and lots of insertions of urinary catheters. Now if you’re not sure what they are, just picture being unable to pee. The agony of this can only often be relieved by having a tube stuck up your penis or female urethra (the pee tube, girls) and into your bladder to drain it of urine. This requires a lot of delicacy (and lubricant!) to make it as painless as possible. After a week of putting tubes where literally the sun doesn’t shine, I realise we are all anatomically very different! Mind you, there are few things less satisfying than taking someone from being in so much pain – to being in so much pleasure – as their bladder is emptied (and I am talking draining off 2.5 LITRES!).

So yes, the days were manic. For 4 out of 5 days this week I started at 7am and finished at 9pm. I had lunch when I got home…i.e. alongside dinner. By Thursday it was fair to say that I was a zombie and dreading being on-call for surgery the next day. Now I can’t recall if I’ve mentioned on-calls before. If I haven’t, let me re-cap. Being on-call means that you do your normal day job (so for this week that meant catheterising as many people as I could!) but you carry a second pager – the on-call pager. When this goes off you leave whatever you are doing for your normal job and go and assist in a surgical emergency or review. So for me, last week this meant going to A&E to assess a patient who may have a problem that requires a surgical intervention. The strangest of things happened on Friday when I was on-call though…the pager didn’t go off once! By 4pm I was paranoid the battery MUST have run out…but you know it was working fine and in fact it was just a quiet day. The surgical gods were shining down on me.

Being a doctor for three weeks is still scary. Every decision you make is a real one. It has real consequences for with every action I take, there is a reaction. If I for example send someone on the wrong type or dose of blood thinning medication, and they then fall over and bleed to death – that will be my fault. If I insert a catheter in wrongly into a male I can rupture his prostate (and gland by males bladders) and leave him unable to pass urine with control for the rest of his life. Even the insertion of a simple needle to take blood into an elderly lady could introduce an infection that could cause a bacteraemia (blood infection) and send them to their grave ultimately. This are considerations that I have to force myself to remember every time I take an action – even though in my mind I have 50 of these decisions circulating in my head at the same time for all of the patients I am looking after. Time is a luxury a junior doctor NEVER has.

I want to end by sharing my most embarrassing moment yet as a doctor. Keeping this anonymous I have changed names and ages. I was asked to perform a gynaecological examination of a lady who did not speak any English. This type of exam which involves feeling for the womb was important in this instance as we were worried the patient had some kind of mass that was obstructing her bladder. This is not a straightforward process as the first issue was that I wasn’t happy the patient understood me – and therefore could not consent for the examination. So off I trot to find someone in the hospital who speaks her native tongue! Once found, I relayed though the translator what I want to do. Consent gained, I performed the internal examination with a female present…and low and behold I COULD feel a mass. Now usually a womb should not feel bulky, firm or fixed. This however felt all of these things.

In my excitement of finding a positive finding on examination I ordered a pelvic ultrasound scan. With this dropped off in the clinical imaging department I rushed back to the other 10 million jobs I had to do. And then “bleep bleep”…the pager rings off. I return he call and it is a consultant radiologist at the end of the line….

“Is that Dr Knight?”

“Yes, it is. How can I help?”

“You order a pelvic Ultrasound scan for this patient because she had a bulky uterus [womb] on examination, correct?”

“Yes I did”, I say confidently.

“This patient has had a hysterectomy [womb removed]”.

“Ah, I see”.

That was a lesson for me. If you want to avoid looking like an utter tool, check the patients past medical AND SURGICAL history very closely!

Have a great week, all.

Dr Nick

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The Twelve Days of Initiation…..

So I am still a doctor. I have survived my first 12 days straight – two weeks and the weekend in the middle. It was as if time, life and anything outside of medicine ceased to exist for a while. I would wake up at 5.30am – in shock, crawl into something reasonably sensible and then blindly stumble to the train station. By 7am I am trying to claw together various blood test results, CT scans and referrals while simultaneously infusing as much coffee as I could into my depleted body. The first week was definitely more imposing than the second week just because I could see the weekend on-call (which means I am the junior doctor looking after ALL the surgical patients in the hospital while their regular teams have the weekend off) looming in the distance, teasing me at the challenges that lay ahead over those two days. But all in all I survived. Nobody died. I would even go so far to say that I enjoy being a doctor.

So let me paint a picture of a typical day for you. Well, I suppose I have already painted the picture for you up to 7am. From then I rush to ‘handover’ where we may pick up patients (I like to affectionately call them my punters) who may have come into the hospital via A&E overnight and be looked after by my team. After that it’s off for a ward-round with the consultant and the team. This can be a rapid affair that demands the superhuman skill of writing 200 words per second if you have any chance of keeping up with what is being said. Good arm strength is also a pre-requisite to help balance the piles of notes that you carry around (one patient had SIX sets of notes…which is a lot!). After the round the senior members of the team peel off to go and operate, while I and my junior team get to work on all the jobs. So – I bet you are thinking that I am about to tell you lots of exciting tasks and life-saving procedures….hmmm not quite! Our days consist of:

–          Taking bloods (lots of this!)

–          Inserting cannulas and urinary catheters

–          Performing arterial blood gases (where I stick a big needle into your radial artery)

–          Discharging patients

–          Prescribing pain relief and intravenous (inside your vein via the cannula tube) fluids

–          Assessing sick patients (surgical patients can deteriorate very rapidly)

–          Writing referrals to other teams to ask (well, beg) them to come and review a patient

–          Requesting (again, begging) clinical imaging to X-ray, CT or ultrasound our patients

–          Eating the nurses biscuits

–          Walking around with a stethoscope around our neck (that is actually hardly ever used)

Now don’t get me wrong, these things are all very important and it is a ‘right of passage’ of sorts. I watch with envy the senior members of the team making real medical decisions and I guess in the end it spurs you on. Plus, on the good side, I am a procedure junkie – I love poking and prodding patients, and what I like to call ‘chasing the vein’ to get a blood sample!

Memorable moments from my first 12 days have included two very unwell (septic) patients who I had to help stabilise, a kiss on the cheek from a 70 year old patient on discharge, being asked if I was the senior registrar on the team (I wish!), gaining access to the nurses stash of Cadbury’s Roses, and successfully cannulating both feet on one critically unwell patient. Low moments – being shouted at by the ITU registrar, not eating lunch for 3 days on the trot as it was just too busy, exhaustion and hallucination, the bizarre dreams I have every night about patients and procedures that need doing, and most definitely getting my stethoscope caught on the bannister and nearly strangling myself. I guess the three rectal exams I had to do in A&E on Friday afternoon weren’t all that fun either!

I can tell you with all certainty that the sleep on Friday night and subsequent lie-in on Saturday morning this weekend was by far and away the best of the year. I slept so deeply and so solidly that it scared me – I must have been utterly exhausted. With 24 hours off under my belt now I am looking forward to the next week of work. I’m proud to be a doctor, have a great team around me, and I you know what – I think I actually enjoy the chaos!

In other news I had a date today. This was however not a huge success, so I am somewhat licking my wounds this afternoon. At least medicine will keep me busy….

Have a great week.

Dr Nick

And so it begins

Quote of the Week:

“Never give in–never, never, never, never, in nothing great or small, large or
petty, never give in except to convictions of honour and good sense. Never yield
to force; never yield to the apparently overwhelming might of the enemy”

– Winston Churchill

My Week

I think this quote is quite fitting for the week that is coming to an end and the week that is about to begin. The front end of last week you see was uneventful – filled with some sunshine, a magazine, the occasional jog and the ubiquitous nap. Then Thursday and Friday happened. All of a sudden I found myself at the hospital (that am starting at full time from tomorrow) I will be working at taking part in a full on two day induction. First of all there was a job of meeting the 35 other new junior doctors and getting to know the people who will be your colleagues for the next 12 months. This in itself is a difficult task since everyone is guarded to reveal too much about themselves and not be ‘that guy’ that tells everyone how, actually, they are really great and you’ll be lucky to work with them!

There is then the second issue of trying to expand, kick-start and blow the dust of your atrophied brain as you have lecture after lecture of information (all by the way that is CRITICAL information that I MUST remember according to every lecturer) from health and safety, venous thromboembolism and anticoagulation to how to use the several IT systems that I require to do just about everything from ordering X-rays to discharging patients. To be honest it was all pretty overwhelming, exhausting and scary – I’ve no shame in saying that because well, it’s true. Judging from the faces around me, I would say I was in good company with my thoughts.

So ensued the weekend – that 48 hour respite before it all kicks off. As I sit here on my balcony looking over London I wonder what the forthcoming weeks will hold. There will no doubt be many lows and, I really hope, some highs! There is one thing doing something in theory such as how to perform CPR and defibrillate a patient…there is another thing doing it for real. With my first ‘on-call’ next weekend that could well be a reality. So here we are, my 48 hours are up and I am staring down the loaded barrel of a 12 day straight run of 12 hour days and 5.30am alarm calls. I am nervous and excited but must of all I want to see if I’m up to the test that so many junior doctors have gone before and passed…

Topic of The Week

This is pretty short today guys as I am flat out stressed for tomorrow and in need of some sleep. So, as a means to provide a little amusement, let me tell you about the vibrating fork. This little gadget, which I am pretty sure you can buy on Amazon, vibrates at a certain frequency when you eat too quickly. Useful why you might ask? Well, when we scoff ourselves, the body doesn’t have time to tell the brain that we are too full and to stop eating. By slowing down the rate at which we eat i.e. chew more times and more slowly, it gives the body time to get the signal to the brain that our stomach is stretched and full and that we don’t need to eat anymore. Simple, yet effective with researchers claiming it reduces the amount of calories consumed significantly per meal leading to wonderful cumulative effects over a year to help manage your weight. That or you turn it up so hard that the vibrations rock all the food of the fork….!

I’ll see you in two weeks guys as I will be working all next weekend..

Dr Nick