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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