Friday, 23 August 2013

Long weeks


So I have been working as a 'Junior Doctor' for about 2 1/2 weeks now, and it has been really busy. For the last 2 weeks I have been in the hospital every day, as I was on call over the weekend. All of these long days, added to the fact that I have only just got internet in my new house have lead to this relative silence on the blogging front, but hopefully this won't be too common (though I have no idea how things will go for the rest of the year busy-ness-wise!)

I am on a vascular surgery rotation for the next four months, and on normal week days my job isn't too hard. I have to stay relatively late sometimes (I am meant to work 7.30/8 til 5, but sometimes need to stay til 8 or 9) but during the day the things that need to be done are not too challenging. Most of the other surgical teams at the hospital consist of an F1 doctor (or several if busy teams), an SHO or two (a doctor who has a year or a few worth of experience), a registrar or two (a relatively experienced surgeon) and a number of consultants (who are the most experienced surgeons and run the theatres and patients in the hospital). Sadly, my team is much smaller, as I am currently at a smaller district general hospital, and most of the vascular surgery is done at the nearby(ish) large teaching hospital. There is myself and an SHO who is a year ahead of me in terms of exprerience (he has done an F1 job already), but other than that we have very little. There is no assigned registrar for vascular surgery (we have to steal another
teams one if we have problems) and the vascular surgery consultants work most of the time at the large teaching hospital, meaning we see one of them once a week for a ward round. All of last week my SHO was on nights, meaning I was left alone to try and organise the ward patients.

While this is a little scary, it isn't as bad as it sounds. Most of my patients are relatively well, and are in the hospital for rehabilitation. This is because most of the seriously ill patients are sent to the teaching hospital for their surgeries (cases like major amputations and ruptured AAA), while my hospital does small, more simple procedures like removing varicose veins, and accepts patients once they are medically well from the large teaching hospital for rehabilitation. This means that I don't usually need to worry about really sick people, and instead need to fuss over blood sugar control in diabetics, and warfarin doses controlling INR. Good practice to start off my F1 job, as it lets me get used to how all these things work, but not too exciting as what I really enjoy is the challenge of diagnosing and treating sick patients. When something does go wrong, though, I am left floundering a little - as there is no-one around to help (for example when I was asked to come and remove a stuck PICC line as an 'expert' [turned out it just fell out])

Despite this, my patients (and I do love saying 'my patients' now, still feels unreal) do tend to stay in the hospital for some time while we treat infections or help them get used to walking again, so I have plenty of time to build up relationships with them. This is something that I have been doing well at, and have had lots of lovely things said to me about my bedside manner by patients and nurses. Always nice to have compliments when you are having to stay 3 or 4 hours past your normal home time to clerk in a patient who was meant to arrive in the morning, but came into the hospital in the evening and needs to be seen.

My on call weekend was very different to my normal day job. Here, there are two F1 doctors (myself and another), who work under an SHO and a registrar to try and run the hospital over the weekend. This is crazy busy, as people get sick at the sme rate, but instead of the normal teams which is probably about 30-40 surgical doctors during the week, there are about 4 of you. The registrar has to spend most of their time in the operating theatre doing procedures, and the jobs come thick and fast. Prioritising is very important, but some wards seem to want to badger you for relatively unimportant jobs while you have more going on. Through a large chunk of Sunday I had to go to theatre to assist the surgeon by providing another pair of hands to hold some of the instruments, meaning the ward jobs built up even further. All you could do was try your best to do the most important jobs, it seems like a very silly system.

After on call and this double week I was feeling very tyre'd...

All in all, I have been happy this week go go back to a more normal job with patients I know, but I am really looking forward to the coming weekend and having some time off! Very thankful that I am not in for the bank holiday Monday though - that is going to be hectic!

Tuesday, 6 August 2013



Here I am, sitting at home, getting ready for an early nights sleep, but anxious about tomorrow. I have completed a few shadowing days working with the F1 who currently does the job that I will be doing from tomorrow onwards as Dr Internal Optimist.

The shadowing days have been a mixed bag. There were a few boring days of lectures, then a big night out with the other incoming F1s on Friday to 'get to know' each other. A good start! This week we have had a couple of days on the ward, following the current doctor doing our jobs - mine was very good - very well organised and had loads of time for the patients. I have to remind myself that he has a years worth of experience on me, and is effectively now an 'SHO'. I hope that I am not expected to be quite as efficient when I start, but I will definitely try!

In the past few days, I have been quite effective, spending a lot of time trying to get patients with problems home from hospital, the most difficult one being someone who is a drug user, has no home, no GP, but we need to discharge while keeping his medications going (so he doesn't turn back to heroin again) and keep his wound dressed. Trying to get a hostel or home to take him was difficult, but he couldn't live in hospital for the rest of his life. He is meant to be going home tonight, hopefully when I go in tomorrow for 'Black Wednesday' he will not be there.

I think it is the things like that where you can make a huge difference by pushing a bit and making an effort, rather than just leaving things to sort themselves out over weeks. I hope I can keep up the good work over the next few months.

Wish me luck, I will keep you updated!