Back Into The Lion’s Den

Having spent 10 weeks in a busy medicine rotation, I am now on the dreaded ‘relief’ term – a term in which I could be in any department to relieve other resident medical officers who go on holiday.

What I absolutely dreaded was the idea of going back to surgery. The horrors of being in surgery a year ago were just too much. The idea of having to stay late, and to put in a tremendous amount of effort that largely went unnoticed was too much.

But having spent a week already in surgery, I’m actually starting to like it. The registrars are quite nice actually. The patient list is manageable at under 15 on most days (unlike the 30 patient list surgery constantly had last year). And the head of surgery from last year has left permanently (she tried to fail my mid term assessment for trivial reasons like having checked a patient’s bloods an hour late when they had a potassium of 5.0).

In addition, perhaps my skills really have improved. Last year, discharging 3 patients and managing the ward on my own was extremely challenging and stressful. I did all that a few days ago, with time left to help out at clinics, and then some more to attend a minor operations clinic.

I have just one more week of surgery, and there will be another person on the team, bringing the total count of residents to 5. Looks like next week won’t be too bad. After surgery – a few weeks of emergency medicine. I hope that goes smoothly as well.

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Back to the Surgical Wards

I’m back on that horrible horrible surgical ward, the ward of bad memories from last year. The constant buzzing in the ward of bells and alarms is all too obvious. I see some familiar haunting faces. Faces that give me a nauseating feeling of disgust.

It’s a good thing that those haunting faces are on the other side of the surgical ward. I’m looking directly back at those past surgical consultants that gave me such a hard time last year, from the desk of the orthopaedics team.

For the mean time, I’ll be looking after bones, joints and wounds, as opposed to botched up colon resections, dehisced surgical wounds, and bladder to abdomen fistula-from-bad-surgery (all of which I really did encounter during my surgical time last year) thank you very much.

Our orthopaedics patients are few in number (sometimes only 5-6 on the ward), generally quite well post op (joint replacements – what can go wrong?), and have far fewer comorbidities. Our team is fairly large too (3 residents vs 4 for surgery, but much fewer patients, and way less clinics).

Some of my registrars still suck, with one even being a registrar from last year. He assigns some of the most time wasting tasks for me, at one time, phoning me up and slowly dictating all the patient details to me so that I could write up a theatre booking form. It was painstakingly slow, dictating the patient’s name, and at times, missing a few letters so that I’d ask him to repeat again. Makes me question the registrar’s judgement in that firstly, it would be much quicker for him to fill the damn form out himself, and secondly, he’s not only wasting his time, but also the resident’s time, therefore wasting two people’s time.

Some things in orthopaedics remain the same as surgery however. The mad frantic rush in the morning ward rounds as we jump from patient to patient, and the unclear plans for VTE prophylaxis, as each consultant likes different VTE prophylaxis use. On the other hand, a lot has changed too. There are way fewer MET calls on our side, or constant requests to review unwell patients, and way less phone calls from other staff hurrying us to get certain jobs done.

Yeap, I enjoy orthopaedics way more than surgery. I’m just thinking how much it sucks for the surgical residents now, but I can empathise with them at least. Been there, done that.

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.

How Can Anyone Survive In Surgery?

As a medical student, I had a terrifying surgical experience. The general surgery consultant grilled me and a bunch of other medical students rigorously, and expected us to know answers to some pretty tough questions. He was a terrifying man, who only slept for 4 hours every day (according to himself), and who backhandedly disguised a praise to his registrar with a nasty comment (“great presentation Dr X, this is the first time you sound like you know what you’re talking about”).

Perhaps another thing that terrified me, was going to theatre. The scrub nurse would tell me off for not scrubbing up properly, because I wasn’t sterile enough (any more sterile and I’d have been castrated ha!). It was my first time, and the nurse didn’t have to be so mean about it! Perhaps the most terrifying scrub experience, was at a rural location where I was needed to assist in a c-section, but was delayed for a very long time because of the scrub nurse needing me to get the scrub perfectly. The consultant was yelling off “come on, I need you here right now!”. I almost gave up under the pressure, but in the end, I scrubbed up, amidst a ton of pressure.

Fast forward to now, and I still feel terrified of surgery. The consultant gives the impression of friendliness, but I feel as if she’s just as deadly, and I feel she will explode some point in the future with rage, rage at us residents for not doing an extremely brilliant job. She has high expectations I feel, and her offhanded remarks at us at times reflect this. We are all doing our very best, and we can’t help it if everything is so disorganized and chaotic!

There are days where panic just sweeps over me because of the tasks I have to balance simultaneously. Consent, x-ray forms, sorting out a man who has passed about 20 mL in the past 2 hours, patient about to be discharged soon etc. It’s just the constant stream of tasks that we have to balance that is freaking me out now. I am afraid that I’m going to make a mistake because I cannot multitask. Afraid that my memory won’t serve me correctly, because it isn’t photographic in nature, and afraid that I will forget some urgent task to be done, because I would have had 2 or 3 of those I am trying to balance at the same time. And I am afraid that I will get a stomach perforation, because I am constantly having lunch or dinner 2 or 3 hours too late. Perhaps they’ll put me through an x-ray and find free gas under my diaphragm?

So, I am still getting my head around surgery. But I am freaking out here because of the consultant, and the tasks I have to balance. The registrars are too busy to help us residents, so we are left to deal with things ourselves, learning from trial and error. What a horrible way to learn from making mistakes. But what doesn’t kill you makes you stronger right?