12 all out

An hour ago I handed over my on-call bleep to a (disgruntled) SHO about to start her night shift. This act signalled the end of a 12 day stretch of shifts. I should be pleased (indeed I am), but right now I don't have the energy to celebrate too much.

The Monday before last, I came into work with a smile on my face, full of enthusiasm. We were one SHO down on our team as she was working nights but we would manage just fine. The consultant ward round that day went smoothly and the jobs were done by 6pm - a good finishing time.

The next day we were without a registrar, but we coped. I even had some excitement, correctly diagnosing a benzodiazepine overdose and reversing it with flumazenil, impressing the nurses and medical students in the process.

As the week wore on however, we started to flag. The work load was increasing, patients seemed to stop responding to our treatments and our finish times were becoming later. By Friday I was well in need of a rest. The "Friday feeling" was very much evident on the ward that day - everyone looking forward to the weekend. Everyone, that is, apart from my team, as we had a weekend on call approaching with alarming speed.

So the weekend was spent on EAU, clerking the new medical admissions. I love this, it's medicine at its best. Be the first doctor to see a patient, stabilise them, do some initial investigations and start some basic treatment. Any problems and you have EAU consultants and 2 registrars to give you advice. Saturday was chest pain day. Lots of ECGs and troponins were done, but I made no diagnoses of ACS. We had 19 patients on the post-take list. Sunday was less busy with 16 patients clerked, but we had some proper sickies. I went off to see a ?NSTEMI on our cardiac care unit, only to find that it was actually a STEMI and needed thrombolysis. Very exciting stuff.

The weekend itself was alright but I was well and truly shattered on Sunday night. Unfortunately I had to do it again on the following Tuesday, on call with another team for the day - my 3rd 13 hour day in 4. This was also my birthday and so I was hardly pleased to spend the majority of it in EAU.

Our list wasn't getting any smaller and our next take was getting ever closer. Thursday I was on the ward alone whilst my SHO and registrar went back to EAU to clerk some more patients. They even stole my med students, who (unsurprisingly) found the prospect of clerking new admissions more exciting than ordering scans and bloods for me on the ward.

Miracle of miracles, we managed to get rid of all our patients that we took yesterday (short stay cases stay under the EAU consultant) and our list remained at 25 patients. And so roll on Friday - day 12 of 12. Registrar-led ward round, we finished by 1pm, but we had a LOT of jobs to do. This afternoon was utter chaos. I've removed 3 chest drains, pleurodesed another drain, done 3 cannulas, taken 7 sets of bloods, discharged 3 patients, done 3 TTAs for the weekend discharges, checked 6 chest x-rays and made 2 referrals.

And, just to finish off the stretch, I had another 13 hour day today. Ward work finished, I headed off to switchboard to pick up the ward cover bleep, being the first point of contact for 9 medical wards from 5-10. Luckily it was a quiet night. My biggest concern was a hyperkalaemic patient with poor IV access but we sorted it eventually and he got his calcium gluconate and insulin before he had chance to develop any funny cardiac arrhythmias. Come 10pm I practically threw my bleep at the poor night SHO.

So yeah, right now I'm drained. I literally have no more to give. I love this hospital and the town it's in, but I need to run far away to recharge my batteries. So at 6am tomorrow morning I shall be on the first train back to Manchester where I can go and think about something other than medicine.

Not dead!

Wow, has it really been a month since I wrote that last post? That means that I have been working for a month as well. I guess that I underestimated just how busy I would be and this blog has been pushed to the background. I would promise to update more frequently from now on but it would be naive of me. The thing is, I just don't have the free time that I was accustomed to as a student, and when I am free, normally sleep is the thing that comes to mind, not blogging. Make no mistake, I'm going to keep this blog going, it's good to know that it's there when I have the time. Just don't expect daily posts, that's all. I'm going to aim for a "quality, not quantity" approach I think. Whether I succed or not, I shall let you, the reader, be the judge...

So what's been going on? Well, like I said, I've now been working for over a month as an FY1 doctor in O&G and it's been quite an experience. There have been highs (being successful at every cannula over a week) and lows (missing three cannulas in a morning, bringing my successful run to a quite catastrophic halt). The best thing I've done so far is assisting on a caesarean section on my first morning, and being the person to push a baby out of its mother's abdomen, then cutting the cord. All in all, a very surreal experience and I felt very privileged to be able to participate in this. The worst moments are the inevitable moments of self-doubt - the "am I really good enough to do this?" moments that I'm sure are normal to all newly-qualified doctors. Pharmacy have saved my skin on one occasion (I love the hospital pharmacists - every last one of them!) , and although I was merely prescibing what I had been told to, it's my name on the prescription and therefore my responsibility to check that what I write is correct. I certainly learnt from that experience and will make sure that I'm more careful in future. Also, an angry patient and her relative tried to make me the focus of a complaint when I had done nothing wrong. This was dealt with fantastically by the senior ward staff but it's still confidence-damaging.

My first bleep - that was a special moment of course. I was sitting at a computer in the library going through the mountain of junk emails that the hospital trust sends me every day when it happened. I calmly walked over to the phone outside the library (pulse racing of course - I've never felt more like a "real" doctor) and rang the extension....only to find that it was the ward sister asking me to rewrite some paperwork because it had been done incorrectly. A bit of an anticlimax in the end.

I haven't yet had to do any on-calls. This is because my job in O&G is supernumary (i.e. no one would notice/care if I didn't turn up for work one day) and so I'm not included on the on-call rota. I feel that this is a mixed blessing. When I see my colleagues being bleeped senseless, running about stressed muttering about "post-takes" and the like, I feel a bit left out - a bit "doctor-lite" if you know what I mean. I've put my name on the list of surgical locum F1s and so I hope that I will get to do some on-call if the general surgery rota is ever a bit short and I'm available. There are a handful of us supernumary F1s in the hospital and it seems ridiculous to me. There are unfilled general medicine/surgery F1 spots on the rota and here I am, doing a specialty that I don't particularly like and where I'm not particularly useful. Yet the trust will pay twice my salary to locums to cover the shifts that I would be more than happy to do. And we wonder where NHS funding can be saved...Anyway my next placement is respiratory, widely recognised as hell on earth when it comes to F1 jobs so I shall more than make up for my lack of work at the moment.

That last paragraph makes it sound like I'm sitting around in the mess all day drinking tea and playing snooker. This isn't quite the case. Just because I'm not needed doesn't mean that there isn't work for me to do, particularly on gynaecology where I'm often working 10+ hour days. I don't mind this too much - it's good to be busy and the more time I spend working, the more I learn. So yes, I am working hard, just maybe not quite as hard as the poor souls who are on-call for medicine/surgery.

This has become an epic-length post so I think I'll leave it there. Hopefully I shall update you all again in the not too distant future.

Simon