Unexpected Birth

Working in the ED is not without its own source of entertainment. From drunks to drug addicts, to patients with actual medical illnesses and emergencies – there are plenty of cases to learn from.

A 20 year old girl attended ED with abdominal pains. She had just found out she was 39 weeks pregnant the other day. She screamed for help in the bathroom, not knowing she was actually in labor.

Nurse: Congrats, it’s a beautiful baby boy!

Boyfriend: If that baby’s term, it ain’t mine.

It was a full term, healthy baby boy…

Locuming

I’m on vacation this weekend. Only, last week, one of the residents from the old hospital informed us that the old hospital was looking for someone to locum for a week for £35/hour. I jumped on that as quickly as I could, especially since it was with my old surgical team. Unfortunately, I didn’t get the whole week, but Monday and Wednesday only – the two big non-surgical days.

It was nice to be back. I knew exactly where to go, I knew what to do, I knew where to find things, I knew who to call when I needed it. It felt great. Despite not being able to enjoy any actual surgery those two days, I felt on top of the world. Plus I didn’t mind staying late when I had to because I was getting paid hourly.

This is one of the perks of “graduating” from being a first year doctor to a second year doctor – you get full registration and are able to take up extra shifts anywhere else in the country. I believe you normally go about it via an agency, but if you know the managers at your old hospital, you can pick up shifts that way as well by being added onto the Staff Bank.

In a way, I’m glad I only worked two days, and not the entire week. Now I get to enjoy the next four days of sleeping in and lounging about.

This reminds me, I need to learn the entire head and neck anatomy by Tuesday so I’m ready for my grilling… And the boss loves his details too.

House On The Hill

The last four weeks have been chaotic. Moving out of one place, starting at a new hospital. New home. New city. I’ve been at my new home for a week now, and we’re still settling in and unpacking. Didn’t realize how much stuff we’ve accrued over the last year until we saw the moving van filled with out belongings.

I’ve also not been fully introduced to everyone I’ll be working with in ENT. All us newbie docs had an induction on the first day. On the second day, I was sent away to Brighton for a full day course on ENT. It proved to be very useful because we went over some medical emergencies and common problems, and how to manage them appropriately.

I started actual work on nights, having swapped my shifts in October. So I worked Saturday and Sunday night this past week. I was freaked out going in because I didn’t know what to expect. I didn’t know where to go. Apparently, there was another induction for all us ENT trainees last Friday, which I didn’t attend because I wasn’t emailed about it. I felt completely lost when starting. The other doctor who was finishing his on-call was nice enough to give me a brief run down as to what to expect.

My two first nights were manageable. I was the only ENT doctor in the hospital, so it was daunting when I was paged to go see patients for review, or patients who attended the emergency department with problems. But thanks to the course, it was fairly easy to get through the night. And it wasn’t awfully busy. And, as a bonus, I got a good amount of sleep in too.

Monday morning was good because that’s when I met more of the team, and that’s when I felt that there are actual senior doctors around that I can ask for help. Unfortunately, I don’t have any more day shifts until next Tuesday. I go for another weekend of nights this week.

Having so much time off is weird. I feel like I should be more productive, but I’ve been in this lull where I don’t want to do anything. Slowly coming out of it though. We’re renting a two bedroom house, so I’m using the extra room as my “man cave.” Finally got around to tidying it up. Still have things to put away, but I think I’ll prioritize with all the expenses I need to claim for the last month first. Then worry about setting up all my hospital accounts before work Friday night. Then whatever else comes my way.

A Week of Being On-Call

I’ve realized that being “on call” at my hospital as a first year doctor is different than what my other friends are doing in the UK, and it’s a whole lot different than what my friends in North America are doing. In North America, being on call usually means you are supposed to be around and available for 24 hours, if not longer. My other friends in the UK are usually on until 10pm, and if they’re on call, it means they’re on call from 8am-10pm, or something along those lines.

For me, being an on call first year doctor in surgery, means that I only answer my pager from 5pm until 9pm. I come in in the morning and work with my regular team from 7:30 until 6pm. At 5pm, I pick up the on call pager and I have an hour overlap between both jobs, which is usually manageable.

Since most of the surgical teams work until 6pm, I don’t often get paged anyway, unless it’s a nurse from one of the wards that needs medications prescribed. I really enjoy being on call because it’s where I get to pick up a lot of my practical skills.

This week in particular. I’ve successfully taken ABGs and analyzed them. I’ve perfected my cannulation skills. Taking bloods is a breeze. And this week, I’ve changed my first suprapubic catheter. These are things I don’t often do when I’m not on call, as breast and endocrine surgery usually has relatively stable patients that don’t stay in the hospital for long.

And now after a Monday-Friday of working from 7:30 to 9pm, I am off for a full week. Hello vacation =)

Job Satisfaction

The other first year house officers I work with despise the job! Like, they genuinely loathe breast and endocrine surgery. And I would normally understand because they have no interest in surgery at all. But now I’m starting to realize that they don’t hate the job because they don’t like surgery, but it’s because of the type of work we’re doing.

We’re not learning. We’re not managing patients. We’re often doing odd jobs that could be considered secretarial. Hence why we started calling ourselves glorified secretaries. We’re calling bed managers to arrange beds for patients. We’re calling couriers to deliver patient notes between hospitals. We’re calling secretaries from other hospitals in order to have operation notes from a surgery in 2013 faxed over for our consultant. I guess it can be stressful, but my two colleagues seem to stress over it a whole lot more than I do.

And at the same time, I guess they’re failing to realize that there is plenty of opportunity to learn and gain experience. We see patients twice a week during our own pre-op assessment clinic. While they focus on co-morbidities and ordering every appropriate test they can think of to make sure the patient is clear for surgery, I spend my time taking a full history and conducting a thorough physical. So a person has diabetes, but they’re not on insulin and it’s relatively well controlled just on oral metformin. I’m not going to freak out and email everyone about this patient asking whether they are to come in a day early.

And so what if I get yelled at by a senior doctor?! I take this as a natural process that it supposed to happen during your career training, and to be quite honest, Brits are super, super, super nice when they’re telling you off. It’s absolutely impossible for me to be offended by anything they say. Maybe it’s my thick skin? But I’m able to take getting yelled at with a grain of salt and learn from it. And luckily, I don’t get told off too much either.

Overall, I am somewhat satisfied with my job. There are a lot of things to learn, and it’s not the medical knowledge I’m talking about, it’s the practicality of the job – what to do and when; when to call for senior advice; who to call for senior advice. I’m fairly confident that I know my limitations on the job. And every day is a time to learn. Unfortunately, agreeing with my house officers, there isn’t much opportunity to learn patient management on this job unless you’re on call because we barely have ward patients with breast and endocrine surgery. And when we do, they’re (thankfully) complication-free.