Anatomy of a day shift

A mere six months after the first post in this series, I’m going to continue my Anatomy of… series and tell you about a normal working day.

Anatomy of a Day Shift

08:05

I pull up into the hospital car park, grab my bag and make my way towards the main entrance. When I was working as a junior physician, we started work at 9am. Anaesthetists start work an hour earlier, which gives us time to pre-assess our patients before the operating theatre lists start at 9. I’m well used to the earlier start now and one of the good things about it is that there’s always plenty of space to park in the hospital car park and I don’t have to drive around it for five minutes every day trying to find a vacant spot.

08:10

I’ve decided to come to work “casual” today, so I change into some scrubs before I go and see the patients. At our hospital, there is a distinct shortage of “medium” and “large” scrubs, but plenty in the “XXL” and “gigantic” sizes, but today I’m lucky. I quickly change into the scrubs and head out to find a copy of the anaesthetic rota so I can find out where I’m working.

08:11

Chair Dental

Dr McAndrew

Dr Anderson

Fair enough. I actually really quite enjoy chair dental lists. When children need teeth extracting under general anaesthesia, they can come to one of the chair dental lists. What’s meant to happen is this: The child enters the room with their parent, sits in the dentist’s chair. The anaesthetist gives a quick gas-induced general anaesthetic, the dentist whips out the offending teeth, the child wakes up and then goes home. It’s very quick, it’s very simple and I really enjoy meeting kids, so I find these mornings really good fun.

It takes ages for the nurses to get all the children checked in and prepared so the chair dental theatre list never starts on time. The children have all been seen in the pre-assessment clinic so there’s little point in me going down there and waiting, I just get in the way. I make my way to the doctor’s mess to have some toast and a cup of tea.

08:50

I wander into the theatre and say hello to the theatre team. Catherine is the dentist today, and she’s in a particularly joyous mood. Soon after I arrive Dr McAndrew, the consultant anaesthetist, walks in. I like this man. He’s coming up to retirement and is pretty much the embodiment of the phrase “old school.”

“Look, Michael,” he says to me. “You’ve done this list before with me haven’t you?”

I nod the affirmative.

“So you know that it’s basically fucking boring. If there’s anything else you want to do, or any other list that you want to join that you feel will be more interesting, please feel free to go off and do it.”

“Actually Dr McAndrew, I would quite like to stay and do this. I need to do more paediatric stuff, and perhaps we can do some of my Workplace Assessments this morning as well?”

“Fine, it’s your choice. Tell you what, you can do everything this morning and I’ll just hover in the background and make the occasional sarcastic comment. Show me your paperwork – let’s have a look at some of these forms you want me to fill in.”

The nurse tells us that she’s going to get the first child round and I prepare to give the first gas induction.

The morning passes by pretty uneventfully. The children are well behaved and there were no major dramas. Actually, that’s not true. There were a couple of dramas – one of the children had particularly a particularly stubborn molar tooth. Catherine, the dentist pulled and pulled and huffed and puffed and then the tooth broke and she had to take it out in pieces. She had to stop a few times so I could give the kid some oxygen, but the tooth came out eventually. The last child of the morning was also the oldest (10), so I assumed she’d give me the fewest problems. I was wrong. She got to the stage where she was partially anaesthetised and then her heart slowed down dramatically to the point where it was dangerously slow (down to 32bpm at one point). Dr McAndrew lay the chair flat and I quickly put a cannula into her hand and gave her some glycopyrrolate and this sorted out the problem.

Interestingly, when these things were happening, at no point did I feel out of control, nor did I feel that the children were going to come to harm. These things now seem to me to be run-of-the-mill hurdles that the job as anaesthetist necessarily entails. I guess I’m become more experienced and I know exactly what to do in these situations, hence why these things worry me much less than they used to.

11:30

The other good thing about this list is that it frequently finishes early. This gives me a chance to pester Dr McAndrew into going through a case-based discussion form with me. I have to say, that I’m finding these flipping pieces of paper more and more tedious. Apparently, the forms allow the deanery (who are in overall charge of my training) to tell which are the good doctors and which are the bad ones. I don’t believe this for a second, all they are tedious exercises in form filling. Dr McAndrew tries to make it a bit more interesting and we have a bit of a chat about various neuro-muscular blocking drugs, but really, I just want the piece of paper signed.

12:00

I head back to the Department of Anaesthesia, there’s a lunchtime meeting today, so the consultants, staff grades and trainees gradually filter into the meeting room. Most of the chat is about the pandemic ‘flu and the (lack of) training or advice that we’ve all received. It seems to me that the way my hospital is preparing boils down to “let’s all hope it doesn’t get serious, if we ignore it enough, maybe it’ll all go away.”

12:30

The meeting begins, one of the other ST2 anaesthetists presents a recent piece of anaesthetic research and we have a discussion about it afterwards. Sometimes these discussions just end up with consultants ranting on about their own particular hobby-horse, but today’s was actually quite interesting.

13:00

I pick up my copy of the afternoon list and I’m going to be flying solo this afternoon. I’m doing gynaecology day-case with no direct supervision this afternoon, the patients are all young, healthy women, so I’m not expecting any problems. I go through all the routine pre-op stuff with each of them and then head back to the operating theatres to prepare my drugs and equipment.

13:45

Janet is the ODP working with me this afternoon. After briefing her about the patients and my plan for them, we manage to kick the afternoon theatre list off (just about) on time.

14:15

Mr Jeffries, the consultant gynaecologist, has a SHO and a couple of medical students with him today, so there’s a lot of chatter going on down at the “surgical end” of the patient. Mr Jeffries’ style of teaching is to ask loads of questions at the students in rapid succession and then wait for some sort of response. At first, this seems to bamboozle the students and I smirk to myself as I see their worried faces – I remember being in their position only too well. The medical students are quite bright though, and they soon figure out that by picking just one of the questions that Mr Jeffries fires at them and answering that one, Mr Jeffries would forget he asked the others and then answer them all himself.

16:30

The students have gone now, leaving Mr Jeffries and his SHO to finish the last case. The afternoon has passed calmly and uneventfully, just how I wished. I’ve had chats with Janet, Mr Jeffries and the rest of the theatre team and feel I know them all a little bit better now.

17:10

This is my favourite part of the day. I go back to the ward where my patients are recovering after their operations. They’re all reasonably comfortable and they all thank me for what I did. I wish them a speedy recovery and then go and get changed. As I’m leaving work, Big Ed texts me to see if I’m up for tonight’s pub quiz. I’d forgotten that it was quiz night and was planning on going running this evening. I weigh the options up for a moment then decide that a pint and banter is probably more fun. I text back:

Absolutely! See you at half 7

And then get into my car and drive home.

Respect

I’ve been on call and I remember that I’ve run out of milk so, on my way home, I stop at the corner shop to get some.

A couple of local lads who look in their early to mid 30s join the queue in front of me. They’re obviously in the early stages of a night out and are being loud, not rude or aggressive, just loud. One of them clocks me, and I must have been looking as haggard as I felt because he pulls his mate aside and says

“ ‘Ere Jonno, let this geezer go first.”

I’m not in any particular hurry so I reply, “No, no, you were here first” and gesture for them to go ahead.

His mate has turned around to look at me and adds, “Nah mate, after you.”

“Thank you very much,” I say and step forward to pay for a litre of semi-skimmed.

“Thank you very much,” laughs the first bloke as he does a bad impression of my accent. “Are you a student or something?”

“No, a doctor” I say.

Immediately this bloke’s hand comes out to shake mine. “A doctor!” he exclaims and whistles gently. “What are you a G.P. then?”

“No,” I reply, “an anaesthetist.”

He enthusiastically shakes my hand again, “you guys do a great job.”

“Thank you,” I say. “Enjoy your night, fellas” I add as I turn to leave the store.

As I’m walking out a hear his mate saying, “Wow, a real doctor! Can you believe it…” and I smile to myself as I make my way home.

Dear Nurse

Dear Nurse,

We are not going to take this old man to the CT scanner. You asked me why and I told you the reasons. He is a 91-year-old nursing home resident. He has a GCS of 3, his right pupil is fixed an dilated, his blood pressure is 212/95 and he has a heart rate of 54 bpm. The paramedics say that he had a dense left hemiparesis when they arrived and now he is unconscious.
I can see that you have a smart navy blue uniform and your badge says that you are the "Acute Stroke Lead Co-ordinator" or something, you are obviously a very important person. You can threaten us with clinical incident forms all you like, but I totally agree with the med reg on this one, going to the scanner would be a pointless waste of time, money and effort. There's no need to quote the NICE guidelines at me, I know what they say, but sometimes you have to ignore the guidelines.
Unfortunately, this man is going to die - CT or no CT - and what we should be doing right now is trying to make his last few hours as comfortable as possible. He needs care and to be allowed to pass away with dignity. He does not need a CT scan.

regards,

Dr M. Anderson

Something that made me smile

I guess I'm really sad, but I actually find this quite funny.

I should have got it done years ago

Walking down the corridor I spy Andy, one of the surgical SHOs who gives me a wave. He’s just come back from a holiday in Spain and is looking extremely orange tanned.

“Hey mate, how was the trip?” I enquire

“Absolutely brilliant,” comes his chirpy response. “Seven days with nothing to do apart from lounge around and drink beer.”

“Nice one, I’m almost jealous.”

“You ought to be.”

“And you seem to be doing a reasonable impression of Dave Dickinson at the moment…”

“Hey… don’t you start knocking our Dave! Anyway the tan’s not the only thing I got out there”

“Oh really? What else did you get? The clap? I’ve told you about this before…”

“Cheeky twat!” and he punches me on the arm. “No, I was talking about this…” And he gives me a conspirational look and rolls up his shirt sleeve to reveal a rather large tattoo on his right arm.

“Oh, you got it in the end.”

“Yeah, what do you think?” I study the design for a moment. It’s actually rather a good one. Admittedly, it doesn’t really go with the cuff linked shirt that he’s wearing, but with a different outfit I reckon it’d look really good.

“I like it,” I conclude. “It’s a bit bigger than I thought you were going to go for, but I think it looks really good.”

“Yeah, I thought there’s no point getting one unless it’s a big one and I really love it! I should have got it done years ago.”

“Well, you did keep banging on about it for ages, so at least I don’t have to listen to that anymore. But honestly, it looks good. I’ve got to get back to ITU though, I need to put a central line in before the patient goes to the CT scanner at 11:00. I’ll catch up with you later.”

“Yeah, see you mate,” replies Andy and off he flounced back towards the surgical wards.

What a way to start the week!

So, I arrive at work today feeling all refreshed and keen after the long weekend. It’s just after 08:00 and I walk onto the intensive care unit, where I’ve been rostered to spend the day. The consultant, Dr Amduno, is already on the unit and as I walk on, he says, “Michael, could you go down to the medical and give Nathan a hand with a patient down there? I’m sure he’ll fill you in with all the details.”

“Sure,” I reply and do a U-turn and head towards the medical unit

Nathan is another anaesthetic SHO and he’s been working all night. When I find him, he’s with one of the registrars, fiddling with the portable ventilator. Nathan tells me that he got fast-bleeped to see this man who was fitting. The usual treatment hasn’t worked, so he intubated the patient and was in the process of preparing him for a transfer to the radiology department for a brain scan.

Nathan has got the man’s physiological parameters under control, so there wasn’t a great deal for me to do. I made myself useful by helping roll the patient so we could sort out his knotted hospital gown.

Nathan looks after the patient’s head and I grab the man’s hips. With the help of a couple of nurses, we roll him onto his side. As we hold him in that position while another nurse sorts out his gown, I feel something warm and wet against my leg.

I’ve got a bad feeling about this, I say to myself. When we roll him back and I let go of his sheets, I see that there is indeed a large damp patch on my right thigh. I touch the patient’s sheets again. They’re soaked. Oh no. I pull a face and look at the nurse.

“That’s not saline is it?”

She looks at me sorrowfully, shakes her head and replies, “I don’t think so.”

I look at the clock. It’s 08:14. I’m less that a quarter of an hour into the working week and I’m standing in clothes that are damp from a stranger’s piss. Whoever said that being a doctor is lamorous work is definitely lying. I wonder why they never show things like this on telly…

Refreshed and recharged

After a particulary laid-back, beery and very enjoyable bank-holiday weekend, I'm actually looking forward to getting back to work tomorrow.

Let's see what this week brings.