Thinking of a career in emergency general surgery? Read Dr Mike Davies' account of working in ESGU.
6.45am and I’m out of the door heading towards the train – I’ll regret not having that coffee. It’s still dark and as usual I’m blasted by the delicate gale force River Mersey wind.
The day starts at 8am every day with a morning handover. All the surgical admissions to the Emergency General Surgery Unit (EGSU) and Major Trauma Unit (MTU) over the last 24 hours are reviewed and discussed. Everything from assaults, falls, brawls, acute abdomens, obstructions and bleeds... every day brings an assortment of different cases. I take notes of all the new patients heading my way and as two of the consultants running the unit, Mr Ward and Mr Misra, review the CT images with the team I try to convince myself “yep, I can see that… er.”
The EGSU is a fairly new and unique department, being one of the first standalone emergency and trauma surgery units in the country. The department consists of an acute assessment unit, a major trauma ward and the EGSU ward. With up to 13 patients on the assessment unit and 23 patients on the EGSU ward, the pace is fast and the turnover is high. With the SHO on call and the other F1 on nights, it will be just me today. Ward rounds are fairly swift – some bays often read like a bizarre medical Christmas song: “Four diverticulitis, three appendicitis, two bowel obstructions and a diagnostic laparotomy.”
"Some bays often read like a bizarre medical Christmas song: “Four diverticulitis, three appendicitis, two bowel obstructions and a diagnostic laparotomy.”
I have all the blood results from yesterday ready to go for the patients, but somehow my consultant Mr Ward already knows them, off by heart. After the ward round I have a look at the jobs list, two sides – great. My role is to keep things ticking over and make sure the jobs are done so that the patients are seen and sorted. The nursing staff help keep the ball rolling, and we get through the jobs for the morning.
11.30 rolls around and there are 15 sets of bloods to be done and as usual I find myself getting a little nervous; then I hear “Gene, you’re in!” The phlebotomist Gene is an F1’s best friend and blood-taking saviour. With the bloods taken care of, I need to call radiology and convince them to take my request for the urgent CT this morning over all the other F1s calling to pitch their request.
Just as I’m thinking about lunch, the trauma bleep goes off. The team tells me it’s for a motorbike vs car in a high-speed collision and the motorcyclist is being airlifted in to the hospital. The trauma team kick into action with the consultants leading the way to the call. It’s amazing to see: everyone has a role, everyone has a place and everyone knows their job. After a quick assessment and resuscitation the patient is off to theatre. I could get used to a job like this.
"This part of the day is a bit like the generation game: 23 patient names on the board, you’ve seen them, made a plan and ordered investigations; now all you have to do is remember it all"
After lunch, it’s time to chase – bloods, scans, referrals. It feels like spinning plates, but as with anything, after a bit of practice, I’m getting there. Before I know it, it’s 4pm. With nearly all the bloods back and the scans reported, I’m just in time as Mr Misra and the registrar, fresh from the trauma call, have arrived for the afternoon board round. This part of the day is a bit like the generation game: 23 patient names on the board, you’ve seen them, made a plan and ordered investigations; now all you have to do is remember it all. This means I’ll likely go home late, but this way I know all the jobs are done and will avoid waking up in a cold sweat thinking “oh no I forgot…”
At around 5.30 I head off to catch the train home. The train doors close behind me so I can escape the rain and I flop myself onto the nearest seat. I see another F1 in my carriage and from the look of things I’m not the only one who has had a tiring day. The job has its bad points just like any other F1 rotation, but it’s also challenging and exciting.
I’m not sure if I’m a surgeon in the making, but for the next four months I’ll stick with ‘Emergency General Surgery Doctor’ – I like the sound of that.
At the time of writing, Dr Davies was a junior doctor working at Aintree Hospital in Liverpool.