Diary of an FY2 – Going Solo

I am not a surgeon.

I think I’ve always known this. I met quite a number of surgeons I respect and admire, the dramatic impact their calculated butchery can have on patient’s lives. But I couldn’t do it myself. Two left hands? I’ve always seen myself as more a Dr Sparrow rather than Sir Lancelot Spratt.

“Don’t forget. To be a successful surgeon, you must have the eyes of a hawk, the heart of a lion, and the hands of a lady.”

And now I find myself as surgical SHO, a curious state of affairs. When I was an FY1, there was only so much difference between surgical and medical specialities – one discharge summary is much the same as any other. But now I’m an SHO, I find myself with responsibility. People come to me asking questions about stomas and bowel obstructions and so much bleeding from the rear end.

The on-call shift is really something else. As a medical SHO on-call, I would clerk patients as part of a team, directed and supported by the Medical Registrar. Even night shifts, so alien and anti-circadian, were a team effort fuelled by a strong sense of camaraderie. As the surgical SHO on-call at Worthwhile General, I take the referrals and see all the patients. There is a registrar and a consultant  who review the patients and who I can call on for advice. But mostly it’s just me.

And then there’s the night on-call. Oh lord, that was an experience!

Same rules as the daytime on-call, except the surgical registrar and consultant go home. They’re still there at the end of a telephone call, but probably asleep. And as well as the surgical admissions, I also have to clerk the orthopaedic and urology admissions. If the sum of my surgical knowledge could fit on the back of envelope, all my knowledge of orthopaedics could fit on the postage stamp. But what I do know is how to keep patients safe, and I can do that until the sun comes up. Really, that’s what my night shifts boil down to.

The nocturnal on-call teams for Medicine (Above) and Surgery (Below)

So that’s what a night shift is like. The workload is highly variable; it depends on how much the surgical and orthopaedic teams handover from the daytime, how many surgical patients get admitted overnight, and how many surgical patients on the ward decide to get unwell overnight. On most nights, yeah, it is actually doable by one doctor.

 

But it only takes a little bit more work from each of those streams to really get a doctor down. This is what happened to me on a recent night shift:

It’s 2AM. I get called by the A&E registrar. He’s got a patient in Resus who he wants me to see. The story is brief but he impresses on me how sick the patient is and how I need to see this patient sooner rather than later. I have a list of patients stacking up to clerk – it’s already a busy night – but I bite. This patient sounds sick.

The A&E registrar wasn’t kidding. The patient is not quite in extremis but they’re on their way there. I get a quick history and I check what the A&E team have already done…no bloods, no imaging, no IV fluids, not even a cannula.

Just as I’m about to ask for a hand sorting out this patient, Resus is flooded by the medical on-call team, ITU doctors and A&E nurses and doctors. Far from my A-Team, they’ve come for an inbound patient with a cardiac arrest. From across the bay, I hear a flurry of activity – meanwhile, I run around by myself: Cannula in, bloods out, fluids in, repeat in the other arm. I am hyperacutely aware that my patient is OK for the moment but that the situation, like the patient, is very fragile.

Did the A&E registrar ask me to see this patient urgently, knowing that there was a cardiac arrest patient on their way in to the hospital? I don’t want to dwell on that question…

After a while, a Resus nurse was released from the crash call. She helped me get the drugs I needed into the patient. On advice from the A&E registrar, I phoned my registrar. Sleepily, he reassured me that I had done everything I could and he had nothing else to add. He asked me how the night was going. I told him the truth.

“Oh wow. That sounds really stressful.” He said non-chalantly.

“Yeah, it is.” I agreed, feeling so much better for that validation.

Night shifts on Surgery are obviously quite lonely. Gone is the camaraderie of the medical team. Just me and my stethoscope. Fortunately, I’m comfortable in my own solitude – I get on quite well with my own company. (Now who’s pitying the only child!!) However, though lonely, I am still not alone. My registrar is still there in spirit, like Obi-Wan Kenobi. And I am surrounded by angels in blue tunics. They’re called nurses.

On the same night as the Resus Patient, I arrived on a surgical ward to review a patient with hyperkalemia. The Ward Sister took one look at me and said, “Doctor, would you like a cup of tea?”

 

I have seen the hope of my salvation.

What glorious words! What a compassionate sentiment! It’s no exaggeration that that gesture, and that tea, restored me and kept me going that night (especially as I didn’t have time to eat anything that night).

I am a stranger on a strange ward, but somethings remain the same. Despite no longer working in a nocturnal Avengers-style medical team, and despite only having my footsteps for company, I am not alone. I still have registrars on whom I can rely, providing I have phone signal, and I am supported by a host of nurses. There’s tea, and where’s there’s tea, there’s always hope.

I might be going solo but I’m never alone.

Being a surgical SHO is harder than being a medical SHO. It’s stressful and a great deal more responsibility than I’ve had before. I’m out of my comfort zone, but I’m learning. By God, I am learning! That can only ever be a positive thing.

I’ve been on-call a lot this month. Normally, I’d say I can’t wait until Christmas – but I’m on-call then too. You’ve got to pay your dues to play the blues.

P.S. If you want read more about surgical training, my blog is obviously the wrong place. You may want to check out Direct Red by Gabriel Weston instead.