Things I Learned in My Surgical Term

I have avoided writing about my surgical term until now (re: I have been too lazy lately to post much to my blog). It was a time of stress, a time of dread just thinking about work, and a whole lot of hard work with very little appreciation of the efforts put in at work.

Here are 5 of the things I learned about surgery during my rotation:

1. The consultant will blame you for things not going smoothly (read: the consultants are control freaks)

One particular patient seen during the ward round, was only being kept in because of his rising LFTs following a cholecystectomy. If his LFTs were fine, he could go home. The consultant decided to blast me vigorously about my lack of proactiveness in not asking the 6am phlebotomy blood rounds to have taken bloods from this patient so that we could discharge them during the ward round. The only problem: there are no 6 am phlebotomy ward rounds, only the 8 am rounds, and by the time they get to the surgical ward, it’s not till at least 9 am. Conclusion: my consultant is a control freak, and terribly clueless about the hospital schedules.

2. Hard work goes largely unappreciated. It’s all about results at the end of the day.

Despite us interns constantly working 2 hours overtime each day, some of us were told that we treated our jobs like a “9-4” job. We were also slagged for how little discharge summaries we were doing (since we were way too busy with lion’s share of ward work), yet the registrars got more discharge summaries done (the overnight registrar usually has a bunch of time to do them).

3. A met call on surgery doesn’t get you any senior staff – you’re pretty much on your own

My first met call ever was in surgery, after a patient’s legs gave way. Only 3 nurses and another intern attended the met call. Registrars and consultants were no where in sight. Fortunately the incident was fairly minor with only some torn skin (ouch).

4. The sickest patients should be looked after by the least experienced (interns)

Surgical patients are some of the sickest patients in the hospital. Most are elderly, with several comorbidities, and who have gone through some extreme surgery starting with “radical” and ending with -ectomy (ie a major major operation). Subsequently, nurses would constantly be asking interns to review patient A or patient B because of fevers, reduced urine output, high blood pressure etc. Being interns of course, we had hardly any experience with these patients, yet were expected to deal with them. Registrars were no where in sight again (see 3).

5. It’s teach yourself surgery.

Not once did any registrar sit down to properly explain about why we are managing patient A with such a management plan. We had to figure everything out ourselves by reading, and by experience. Asking questions were met with raised eyebrows and judgemental questioning of  “shouldn’t you have learned that in medical school already?”. The worse thing: registrars claiming how much you learnt at the end of the rotation due to their excellent teaching.

So there you go. A list of 5 things that surgery taught me. May I never have to repeat that again.

Having Gone Through Hell…

If I were to use one word to describe my ED rotation, I would use the word “hell”. In saying this, I feel that I have learned an incredible amount of things from my ED rotation, but at the cost of my self esteem, and perhaps a little bit of my sanity.

It wasn’t the stress of seeing unfamiliar patient presentations that freaked me out the most, but rather in dealing with the senior doctors and the culture of degradation of junior doctors.

As junior doctors, we were thrown in the deep end. We were doing the same job that a registrar in ED would be doing, working up the patient, performing appropriate investigations, and making referrals. It was tough work.But this tough work I could cope with. It was even challenging, and something I learned a lot from. The thing I couldn’t cope with, were the staff. Not all were terrible, but I could say that a few were quite bad, with one particular man who seemed to be hated by everyone, including surgical registrars.This man yelled at me on the second day of work. I got yelled in front of almost all the other ED doctors for asking my senior doctor to describe an open fracture he had seen earlier that day, so that I could relay it back to the orthopaedic doctor. Words to the effect of “incompetent”, and “idiot” were used. That night, I couldn’t sleep, dreading the next day and fearing how it would turn out. It wasn’t until just a few days ago, that I found out other colleagues have cried at home from this very man yelling at them.

And so, for the next few weeks, I was mentally tortured by this very man who we had to run all our cases through. He would question my competence as a doctor, carefully pointing out my mistakes, and how I had forgotten to do things such as chart regular pain medications, hence why the patient is suffering excruciating pain.

On more days then not, I sat on the edge of my bed, thinking about the mistakes I made, and questioning myself whether I was competent or not. It was self abuse, and completely self defeating. I would dread the next day that I had to get up to go to work. Finishing work was the most relieving feeling ever, but on days that I was yelled at, or pointed out numerous mistakes, even that feeling of relief was taken away, to be replaced by frustration, anger and thoughts of worthlessness at the end of my shift.

To me, I felt worthless at my job. I wasn’t getting the support I needed, I never got the encouragement or acknowledgement that I was learning from my mistakes, or doing a better job than I was doing in the past. They didn’t take the time to explain my mistakes, and how I could avoid such mistakes next time, but they pointed out my mistakes, reinforcing the message that I was doing badly. In hindsight, I wasn’t doing badly, but I was doing something in which they held unrealistic expectations of  me as a junior doctor.

What doesn’t kill you only makes you stronger right? In that sense, I feel stronger having put up with such degradation, and the subjected self torture. The biggest lesson I learnt was in dealing with ***holes in medicine. Learning to deal with other people – it’s an important life skill, and it will surely help you to survive in this big bad world.