Dr Varun Shankar gives an insight into a busy day on the neurosurgery wards.
It’s 7:28am and I’m on my way to the big morning handover, where all the doctors and nurses go through every one of 70 patients in the neurosciences ward. Most of my patients are currently stable, so there isn’t too much to worry about, however my firm (one of four neurosurgical teams) is on call today, so I know I’m in for a bruiser.
Next it’s the neuroradiology meeting where all the referrals from surrounding hospitals are discussed, followed by the NeuroITU meeting – my favourite part of the day (being a budding ITU doctor I lap up all the knowledge I can). My team has four patients; one of them is being transferred to a local hospital, as there is unfortunately not much more we can do for her. I remember when she came in a month ago with a big bleed. Her family have accepted that she won’t return to normal, but it is still upsetting that a previously well woman in her 60s will never be the same again.
No time to think or dwell too much, as it’s back to the ward for the ward round. My SpR is ruthlessly efficient so this is where I need to move with real purpose. Thank god I mastered how to write and walk during my F1.
During our round we are informed that Ms G has become unresponsive. This isn’t good as this patient has severe learning difficulties and has had numerous EVDs put in over the years due to hydrocephalus. She came in a week ago for an EVD replacement as her last one became blocked. Today she is spiking a temperature and it may be time to replace the EVD again. Within the hour I’ve got to get her theatre ready, get a CT scan and LP done. Luckily, the other patients are all stable.
Ward round over, it’s time to look at the jobs – four CT scans, nine bloods and five discharge summaries to sort out. First things first – get Ms G ready for theatre and a full septic screen done. She has notorious veins – luckily there is a small vein in her hand that hasn’t been destroyed, so in goes a cannula. I request the CXR, do the LP (her opening pressures are within normal limits) and her urine is clear. While waiting for the portable x-ray I go to the scary neuroradiology consultant to ask whether Ms G’s scan can be done first. The neuroradiologist is not too happy, as is always the case first thing on a Friday. He does however agree and asks me to send Ms G for her scan in ten minutes.
Once the CT is done I call my SpR in theatre. My consultant answers the page and informs me that he will send for Ms G in 20 minutes. Ms G’s mother has arrived and asks what is happening. Luckily I know her quite well so I sit her down in an office and explain things. She’s used to the swing of things, but is understandably worried.
Ok, now the biggest job is done it’s time to sort out the other CTs, then it’s the blood round followed by urgent discharges.
I go to lunch at 1pm with my buddy from med school. He’s having a relatively calm day and is hoping to finish on time. Lunch is cut short when I get paged that one of the patients from the neuroradiology meeting has arrived.
I wander over feeling buoyed that I’m running on time and not too tired. Mr M has an acute on chronic subdural haematoma and has deteriorated over the last 24 hours. Walking in I can hear his chest from four feet away – they won’t operate with his chest sounding this bad. I tell my SpR, who is nonplussed as his parent hospital did not inform us he was this sick. He comes up, having finished Ms G’s EVD, and agrees that we need to make him stable first. Another septic screen for me to do. CXR confirms pneumonia. Time to start him on IVABs, but looking at his comorbidities and eGFR, I realise he needs to be on a renal dose.
The scans and the bloods have been done; a few patients have hypokalemia, so time to start replacement therapy.
It’s somehow already 5pm. I get things in order for handover. Ten minutes to finish, I get a page from a nurse. Mr M’s son is here and is not happy we won’t operate. I head over and explain the situation. He calms down after I answer his questions.
As I walk back to the doctor’s office at 7pm to handover, exhaustion hits; I think about what I will do this evening. It’s nearly 7pm and dinner in front of Game of Thrones sounds marvellous. Would I trade in this job for another? No way.
Dr Shankar was working in Leicestershire.