I was looking forward to starting anaesthetics. I was predicting an easy month away from my hectic day job on the surgical progressive care unit
Today I’m with the anaesthetics team in acute theatres. I’m nervous. I’ve only done two days of a four-week programme during my FY1 Critical Care rotation, and so far, I’ve been useless. Yesterday I missed every venflon, I got in the way, even when standing in the farthest corner of the room, I didn’t get a single question on drug mechanisms correct, and to top it off, I looked freakishly like my grandmother in that awful theatre cap. I was reliving nightmarish medical school days, except with pay, and no homework.
I was looking forward to starting anaesthetics. I was predicting an easy month away from my hectic day job on the surgical progressive care unit. The thought of it reminded me of a song I’d heard on YouTube by the Amateur Transplants – a musical duo of doctors – called: The Anaesthetist’s Hymn. “Everybody wonders what anaesthetists do while the patient is asleep. Everybody wonders what we do for three hours while the machine goes beep”.
My impression, after a vaguely interesting first five minutes, was that anaesthetists sit around reading the paper, gossiping, fiddling with the monitor, or adjusting the height of the bed. Alas as five minutes turned to 10 and so on, my impressions changed – it is not an easy life. My first day was an information overload and panic at not being able to get various tubes in. Anyway, back to today, already stressed, I arrive at work, and hit the first obstacle – gaining access to the changing rooms. I spend 10 minutes negotiating with the theatre receptionist, to convince her that I am a proper doctor, not a med student here to steal scrubs for a pub crawl, nor a pickpocket. With access finally granted I lose another 10 minutes battling with the theatre hat to make it look half decent. I fail miserably and it is now 8:20am.
Today I’ll be working with a cheery Scottish ST2 and a shy consultant. We go through the acute theatre list and prioritise patients, combining need and urgency, concomitant conditions affecting the anaesthetic process, and the sheer logistics of getting the appropriate surgeon there at the required time. The first case is a kicking and screaming kid with an eyebrow laceration. Thank God, all I’m asked to do is work out the weight-based drug doses, and not put a cannula in one of the thrashing limbs!
I lose another 10 minutes battling with the theatre hat to make it look half decent. I fail miserably
When the little angel is asleep, the consultant’s questioning begins and the haze of yesterday descends again. The questions are really hard! Well, not hard, but they are questions that I have never considered before like: “Why is tachycardia bad?” I’ve been a doctor for 10 months. I get bleeped eight times a day regarding patients with a tachycardia. It gives you high points on the early warning score chart – it must be bad. But why? My brain is blank. As the day continues, so does the information overload and so do the questions. I listen and respond as best I can. By lunchtime I’m exhausted, but I feel I have got into the swing of things.
The afternoon brings more challenges but to my surprise I overcome them. I’m hitting the most difficult cannula insertions and I insert four laryngeal mask airways. I even attempt one endotracheal intubation. It is going really well until I see the consultant glancing nervously at the monitor checking the oxygen saturations. While I struggle to lift the weight of the patient’s thick-set boxer’s square jaw, the SATs begin to dwindle, I feel the consultant gently pat me on the shoulder, encouragingly saying: “you’re doing a good job”. I move aside and he swiftly slips the ET tube into place. Show off. Despite being exhausted from a crash course in airway management, I’m buzzing and enjoying myself. The rhythmic blips of the heart monitor are soothing. Anaesthetics is a contrast to the pace of acute surgery, but it is equally rewarding.
I think again about the Amateur Transplants song. What do anaesthetists do while the patient is asleep? Well, today I did read the paper and glance at the monitor, but I acquired knowledge and practised new skills, which included learning how to adjust the height of the bed – it is very important after all.
Dr Laura Davison is an FY1 at the Bradford Royal Infirmary.