A day in the life of a general surgical trainee

My alarm goes off at 6.10am and I am up instantly. Showered and ready by 6.30 I make a cup of tea and drink it whilst listening to the radio, unpack the dishwasher and get organised for breakfast. Then I get my children up, chaos ensues as they fight over who should sit in which chair and what they all want for breakfast. By 7am I am leaving, cycling if it is dry into the hospital.

After securing my bike I head to theatre to get changed into scrubs, if I have time I will pick up a coffee and a banana from the canteen and drink it as I walk the long journey from the entrance to my office.

First up, I call into the High Dependency Unit to see my post operative patient from the day before and check her over, look at the observations chart, see if there is any blood in her drain and examine her. Then I quickly rush to the main ward to consent the first patient on today’s list who has just arrived.

My ward round begins at 8am (late by American standards), I see all the patients on the ward and any that belong to my consultants on neighbouring units. I give a plan for the day for everyone and ensure the juniors know which theatre to find me in if there is a problem.

There usually is just enough time to grab another coffee which I drink on the way to theatre where I will be for the next 7 or more hours. The anaesthetist takes an insanely frustrating length of time to get the patient off to sleep. They arrive at work at 0830 and are impatient that I don’t attend the theatre brief at 0830 as I am doing the ward round (Number of patients under my care 37: Number under their care:1). 

The first case is a quick one, we are done at 1030 and I run to radiology as there is a message that the radiologist is refusing to do a drain we have requested. Grovel for 10 minutes and leave with drain appointment booked. Next case goes on table and takes 6 hours, my deltoids ache by the end. I write the op note, the post op orders and go to the ward. The day shift junior doctor has left, as she finished at 4pm. 

The late shift doctor is dealing with an unwell person on another ward. Do ward round alone, it’s 6pm, I haven’t eaten since that banana and coffee at 0745. Relatives of many of our patients all want to talk to me, tempted to tell them to go and fuck themselves, resist that temptation. 

Have to spend twenty minutes explaining why someone’s emergency operation didn’t go ahead, they are very cross. I also feel cross as it is now 7pm and I have eaten 4 celebrations (sweets) to stop me fainting. Cycle home in the dark. 

Receive email telling me that my study leave application is approved (good) but without funding (bad), the course costs £1050, accommodation and travel will be another £400. That’s half my monthly salary. 

Realise I am insane to do this job and I should have been something much better and more glamorous and well paid. 

A difficult patient

A difficult patient

My job is to care for people, we take all comers into Bighospital and we don’t discriminate in any way. Inevitably this means that every now and again we have patients who are either in prison or have recently committed a crime.

The two types of criminals that seem to generate the most hatred are rapists and drunk drivers. Violent criminals, burglars, even murderers are preferable and tend not to cause much upset. They are usually very polite and escorted by two guards who keep them in check.

We recently had a drunk driver (of a lorry) who had killed a family of three, mum, dad, daughter and seriously injured the son. The son was in ICU and we had operated on him, the drunk guy had been lucky and had minor injuries and was sent up to my ward.

When I went to see him I had spent three hours in resus battling to save the mother who died and then the son who lived but was critical. I noticed that I had their blood on my ankle as I sat talking to the drunk guy.

Drunk guy was still drunk, he was in the mood to be funny, he had lots of anecdotes about his own teenage son and about his annoying boss and quite happily confessed that he had been drinking all afternoon prior to getting behind the wheel.

I tried to cut him short with the tipsy banter, not really being in the mood for light hearted chatter, especially with him. The trouble with that plan was that he was actually quite funny. I figured it would be the last time that he would get to have a relaxed and normal conversation for a while and stopped trying to keep him to the subject of did he have any trouble breathing.

I let him tell me everything, examined him thoroughly, reassured him he was ok, there would be no serious sequelae of his injuries and that his priority was to sleep it off prior to seeing the police in the morning.

The police arrived a few hours later and told him that he had killed 3 people. I went in and sat with him, I told him how sorry I was. I imagined he must be feeling wretched. “I’ve ruined my life. I’ll lose my licence” he lamented. I left him to his thoughts and his hangover.

The next morning the amusing drunk was gone, in his place an aggressive and angry man. He wanted to see the medical notes (request denied), he then denied being drunk, he started insisting that he was seriously injured and wanted huge quantities of morphine. Lying on his bed was the headline of the local paper “family killed in road accident”, we all looked at it and back at him. “It was the other guy’s fault, not mine” he said. I looked at him and smiled in what I hoped was a reassuring and non judgemental way, “We are here to look after you, we aren’t the police, it doesn’t matter to us at all.”

Genuinely, I cared about this man, he was a father, a son and an employee. His family and friends were going to be devastated by this event, his life and career ruined. He would possibly never get over the consequences of his actions (I thought) and would have to live with it for the rest of his life.

I imagined how he would be feeling and how his family would feel; devastated I thought.

But this turned out not to be the case, they were rude, they were loud and demanding, accused us of neglecting him whilst we attended to the now dead family, attempted to steal the medical and nursing and notes and caused mayhem on the ward.

It was this that disgusted me, not the crime itself, but the lack of remorse, the lies, the attempts to deny responsibility. I managed to stay civil, to care for him properly as is my job, and I was relieved to discharge him the next day.

I examined my own conscience on this, I had no problem caring for him when he didn’t know what he had done, even when he was still drunk. It was his reaction to what he did that was hard for me to understand. I expected remorse and regret and when that was lacking I was dismayed. I expected his family to be devastated and supportive and they were not.

I’m not sure what this says about me as a doctor and as a person. My colleagues treated him like shit from the outset, as did the police. Maybe I should have too, then I wouldn’t have been so disappointed. It isn’t like me to be so naive, generally I am a hard and cynical experienced old hand with the junkies and the criminals.

I will follow the court case with interest, the notes may end up as evidence and if he contests them then I’ll be called as a witness. Part of me would be glad to recount it all in court.

(the details have been changed to protect identities)IMG_3853.JPG

drive safe everyone

The sun on your face and the wind in your hair: privileges I take for granted

The sun on your face and the wind in your hair: privileges I take for granted

At this time of year when I do a week on call attending to the emergency admissions and usually forgoing lunch, visits to the toilet, any sense of normality etc; I do not see any daylight for 7 days. The result of this is that I crave light and sunshine like a drug addict. I feel strange, I am immersed in work and it’s artificial lighting and the darkness of outside.

On my first day off afterwards I try and spend as much time as possible outside even if it is grey, as it was all of last week until finally the sun came out on Sunday and broke my 13 day run of not seeing the sunshine.

It does make me think how my patients must feel. I have several patients waiting on social care packages who have been on the ward for months. They haven’t left their bay (6 bedded area: we have old fashioned British wards, there are 4 bays and 6 side rooms for 30 patients) for that whole time; there are no relatives to take them to the shop or to the cafe.

It makes me want to cry for them, no wonder they are so sad and depressed. They eat nothing other than the hospital food, hospital coffee and tea, drink water in a plastic glass.

How they must crave the sun, a China cup of tea, a glass of water, a towel that doesn’t take the skin off you. Even the ability to break wind and know nobody has heard you. I would go insane, they must be going insane.

And every morning and evening I come and ask them how they are, and they are polite and lovely and only very occasionally unhappy. Sometimes they mention that they’d love a glass of wine or a steak and we all look pained and embarrassed.

We are obsessed in this country with giving money to charity: I have just seen an advert to sponsor snow leopards followed by one for clean water in Africa. We hand over thousands of pounds but hardly anyone gives that more precious commodity, their time.

Charity is on your door step and it doesn’t always need to cost money.

The relentless grey of British December, better than a hospital wall though.