How can one sheet of a few jotted words per patient seem as important as the Holy Grail when faced with your registrar or consultant?
Beep, beep, beep, beep... It can’t be 6:30 already, can it? Up, shower, shave, dress, out. The streamlined precision of the morning routine perfected over months, shaving seconds off the commute each day, winning back seconds of sleep. Breakfast in the mess (saves buying milk and bread at home) then on the ward for 7:45, hurriedly putting forgotten bloods in before the phlebs arrive, and updating ‘The Sheet’ - the dreaded handover sheet. How can one sheet of a few jotted words per patient seem as important as the Holy Grail when faced with your registrar or consultant?
“But it’s not on the sheet,” he’ll say. And so it goes on. What began as a simple reminder of what needs to be chased for each patient, what their latest white cell count is, and what operation they had, has grown and mutated into a biography of each patient; but he’ll still refer to her as the “lap chole I did last Thursday, what’s her name again”. And so to the ward round, or the more aptly titled ward race. Never have you seen your boss move so fast than when galloping around the ward, with registrar, SHO, nurse in tow, you lagging behind, laden with 18 sets of notes, trying in vain to figure out which patients he has seen, who he is seeing now and pre-empting who he will see next.
“Morning Mrs Smith,” he’ll boom. “How are we today?” “Mr Surgeon,” she’ll gush. “How lovely to see you.” How gracious that the consultant in charge of her care, who removed half her bowel last week, has actually turned up to see how she is. “How’s the pain today my dear? Bowels open? Passing water? Eating well? Drinking plenty I hope? Home by the weekend I expect,” he’ll reel off, as he buries his fist in her abdomen; she flinches but is far too awestruck to cry out in pain. “Actually Mr Surgeon, my anastomosis is leaking, causing a faecal peritonitis and subsequent sepsis, and so unfortunately I won’t be able to eat or drink for weeks, require TPN, a catheter and bowel rest and am unlikely to be home by Easter,” she should say. What she actually says is irrelevant, for he has already moved on, muttering, "obs stable, apyrexial, plan: continue” as he’s racing towards the next punter.
Ward round done in record time, a list of jobs that’s growing by the second, and then: BEEP, BEEP, BEEP, BEEP
Ward round done in record time, a list of jobs that’s growing by the second, and then: BEEP, BEEP, BEEP, BEEP. “Hello, surgical house officer on call,” I say, without thought, as I simultaneously take blood, order an X-ray, write a discharge letter and talk to a patient’s family; who says men can’t multi-task? “Oh hello doctor,” the nurse will say, in a tone that seems unnervingly pleasant. “One of your ladies, Mrs Brown, down here on the rehab ward, her stoma output has been nil for 10 days.” “I’ll be down within the hour,” I’ll say, through gritted teeth, angry, yet unsurprised that something so simple as her bowel movements has been overlooked, in favour of how many stairs she can climb, and whether she can still use a tin opener, when you know full well she lives in a bungalow, and that she has single-handedly nursed her husband through his cancer care the year before, and is one of the fittest, stoical patients you’ve ever met. And irrationally annoyed that the rehab ward is a whole six minutes walk away, six minutes where you can’t get anything done, and six minutes you will inevitably make up for after work.
And so the day goes on, the list gradually becomes bearable, your colleagues offer you a hand and there’s a moment’s respite from the relentless bleeping to grab lunch at about 4pm. The gourmet selection on offer in the staff canteen leaves much to be desired, but to be honest, I’d eat my own shoe at this point, and enjoy it. Just as I go for that first forkful of shepherd’s pie, BEEP, BEEP, BEEP, BEEP – it’s theatres. I consider not answering it, letting them bleep someone else, but the conscience inevitably intervenes, prising you from your food towards the phone. It’s your consultant, he needs you in theatre, the SHO has gone AWOL (you’re sure you saw him headed towards the library). I take one mouthful of pie, savour the greasy goodness, and drag my feet to theatre, mentally preparing myself for the two-and-a-half hour retractor challenge, knowing full well that by the time I manage to escape it will be approaching 7pm, I’ll still have half a dozen bloods to chase and the dreaded list to update, and I’m back in less than 12 hours. Would I ever consider doing something else? Not a chance.
Oliver is an FY1 in breast and general surgery at Dewsbury District Hospital.