Futility 

Futility 

What do I hope the outgoing FY doctors have learned after their time in surgery? For the surgical futured ones there are practicalities like tying a knot properly and closing the skin and inserting ports, as well as hopefully communicating with them the “hidden curriculum” of hard work, professionalism, kindness and care. The ones destined for general practice or other specialties. Someone much smarter than me wishes that they leave with foresight, insight and hindsight, which I love. 

One of the things I want them to leave with is how to recognise dying and manage it well. There are many phrases about knowing when not to operate being more important than when not to; same with ITU admissions and critical care beds. It is really hard to tell someone that they are dying, you can’t deliver it in the same way you tell them that their CRP is going up or down. It takes time and compassion and usually briefly takes a piece out of you emotionally. 

Do not avoid theses conversations, don’t prolong death with TPN and blood transfusions and pointless antibiotics. Do not shrink from your responsibilities and hide behind interventions and futile treatments. Recognise dying and help your patient and their family face it. It’s important. 

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Lesson Of the Day

Lesson Of the Day

I have added one new rule to my surgical pearl necklace. If you try and be helpful and take a case from someone else’s theatre, be prepared for trouble

Today we took two cases from other theatre lists as our list had, in Bighospital terminology, fallen apart. This was partly thanks to me, who feeling cocky and egged on by the anaesthetist, took the decision to cancel a case yesterday. 

Today in Bighospitalburgh the sun was shining, it was warm and the theatre staff were moaning that we were looking for extra work. Every single sign and person was pointing to “get out of here and enjoy an early finish for once.”

Reader, you know that I did not do that. The Daily Mail can relax that a theatre list did not go under-utilised whilst I watered my courgettes.

Fast forward to midday and we have identified no less than 2 patients who we could operate on, taken from other  overbooked lists. 

We went to see both patients and introduced ourselves as the new team, checked the notes and confirmed the consent. 

The first patient woke up after her small procedure complaining loudly that the wrong surgeon had done her operation and that is why she was so sore. She caused a huge fuss in recovery and had to be talked down: lesson number 1 of the day, re-consent everyone yourself to ensure they are adequately prepared. 

The second case was not as advertised. A simple operation (a gallbladder became a nightmare. Lesson number 2: don’t take gallbladders as favours. 

This is not the first time i have been burned by a hot gallbladder parcelled up like a biliary colic when you are trying to be helpful. The last time, my name became linked to someone who was in ICU for months, but that’s a story for another day, the moral being always check an amylase. 

So after a fight with a massive beast of a gallbladder with abnormal anatomy that involved 6 surgeons.

Closest I’ll ever get to a Ted talk:

I got into the car finally at 7pm and raced home to relieve the nanny of my children (arriving late) and did not stop to buy milk, fruit and post a letter as I had planned. Being helpful does not pay!