A new medical officer (NMO) joined the department and was assigned to a surgical team. An experienced medical officer (EMO1) was on call for the operating room call (this MO stays in the OT/OR, does the small cases like amputations, saucerisations and appendicectomies, as well as assisting in larger cases like laparotomies) on the same day as a department farewell dinner. He was looking for someone to ’sell’ his call to.
Operating room calls are hot stuff, they sell like hotcakes to the surgically inclined. Almost every surgical trainee (or surgical trainee wannabe) appreciates more experience in the operating room. Furthermore, OT calls involve no direct responsibility for patients (As compared to the A&E or ward calls), allowing the on-call to focus purely on gaining more surgical exposure.
EMO1 entered the MO room (containing NMO, J., H, K and TJ) and asks to swap out a call. J., H and K are on call the day after EMO1. TJ is on call the day before. So EMO1 asks NMO since (a) he has no calls in that period of time (b) he wants to do surgery (c) he’s a new MO and thus really doesn’t need to go for the department farewell dinner. NMO politely declines since he “doesn’t want to do calls so early”, and wants to do “tag-on calls” first. EMO1 shrugs and says he will just do the call then.
TJ, who is also an experienced MO (EMO2), can barely hide his contempt: NMO is “the person who says he wants to do surgery but doesn’t want to do an OT call”, instead, he wants to do “tag-on calls” – voiced with a tone of disdain accompanied by airquote gestures.
Really, that’s not the way to start building your reputation on your first surgical rotation.
It is most frustrating, when J. is working in a team that frequently updates the relatives of the patients under its care, to be informed via the nursing staff that the CEO of the hospital has received a complaint that the team is “not updating the family enough”.
The complaint came from the daughter of the patient. The team has never, ever seen the daughter in hospital. The wife and son (who are frequently in hospital ad actually take care of the patient at home) get updates on the patient’s condition and plans every day.
It’s a classic case of ‘guilt-syndrome’. The most unreasonable, unpleasant relatives, who demand the best impossible care for the patient are the ones who
(a) don’t live with the patient
(b) don’t take care of the patient
(c) haven’t seen the patient in months-years because work and gallivanting about the world takes precedence over filial piety.
Now that the relative is sick, it’s their chance to show that they care so deeply that they can be utterly unpleasant and impose their ridiculous demands on the healthcare staff.
There are sons who demand that their premorbidly wheelchair-bound parent, a resident of a nursing home, WALK before being discharged from hospital. Sir, if I could perform miracles, I would be curing AIDS with the power of my mind in Africa instead of listening to your arrogant, ignorant ramblings.
People are new. New people take time to catch up, and the first impression is often false.
He was on call with a new HO with a poor reputation for breaking down and almost being in a catatonic state on his first week at work. Most likely he was overwhelmed by being in a new country, in a new hospital, in a new system, in a new department with a horrendous workload for the inexperienced. Let’s say that frequent consultations were had and a couple of serious mistakes were made. J. was not happy.
Yet a couple of months down, said HO was the sole house officer on the same team as J., and having had experience in other teams, proved to be more than capable enough to settle all the changes of the admittedly rather complicated team. It’s a humbling experience for J. to be reminded that the conclusions we jump to about people are often unjustified.
It’s been over a year since J. started working, but he still remembers this experience from a student posting.
There was a 36-year-old lady who had come in with a 3-day history of abdominal pain, starting from the umbilical region, subsequently radiation to the right hypochondrium/flank region, bilateral shoulders and was exacerbated by lying down and relieved by sitting up.
Physical examination demonstrated tenderness over the areas of pain (including the shoulders) but no guarding or rebound tenderness, a low grade temperature of 37.6 degrees, BP 100/60mmHg, pulse 90 beats/min, SpO2 100% on room air. Initial investigations: Hb 11.6, TW 22.1, Plt 200, PT/PTT renal panel (U/E/Cr) liver function tests and serum amylase levels all normal.
She was admitted to General Surgery, who initiated basic cultures, fluids, antibiotics and ordered a CT abdomen/pelvis to look for any possible perforated appendix/viscus as she (as the registrar pointed out, “she doesn’t look too well…”). This lady was in sufficient pain that she needed IV morphine 2mg in order to lie down flat for the CT scan. Right before the scan, however, the registrar noted that her bladder was full and she had not been catheterised. He considered that her last reported menses was 1 month prior and lasted only 2 days (instead of her usual 5). He then flipped through the A&E notes and noted that the urine pregnancy test had been ordered but had not been performed (since the pt had not passed urine). The GS medical officer catheterised the patient in the CT scan room and ran the urine combur 9 and urine pregnancy test.
Positive.
CT scan withheld, O&G registrar informed, and the patient was wheeled to the labour ward immediately where a repeat pregnancy test was confirmed, and a transvaginal ultrasound demonstrated free fluid in the peritoneal cavity and a right adnexal mass – confirming the diagnosis of ectopic pregnancy. Care was handed over by the GS side to O&G who proceeded to prepare the patient for an operation. One life saved, thanks to an astute GS registrar.
That was the only case ectopic pregnancy J.’s seen… The UPT must always be checked for any woman of childbearing age. That’s what J. thinks when he sees a patient in the A&E referred to GS for abdominal pain.
It used to be a hugely popular site called “Top 46 Freeware Programs”. The owner seems to know his stuff and the site is frequently updated. Over time, I’ve noticed that popular adware programs like spybot s&d and AdAware have decreased in efficacy… and Gizmo’s right on top of every new development.
Tired of Norton/McAfee and wondering what free antivirus program is available? No money for Quicken but want a personal finance manager? This is the site to go to.
I am going to take the MRCS (Member of the Royal College of Surgeons) Part 1 and Part 2 examinations in a couple of days time, and feel ridiculously unprepared. In the past weeks, I’ve been cramming at any time possible, and feel very glad that the department I’m working at now has been able to grant me study leave to revise.
Before we go ahead, though, here’s something that needs to be pointed out.
Consent is not a get-out-of-jail-free card for negligence.
No one said it was.
Whenever a complication happens, despite the pre-operative counselling, the patient and his/her family look for someone to blame. It must be the surgeon’s fault! It was the inexperienced one, wasn’t it? The operation wasn’t kept as clean as it should be! The surgeons only want to chop and a smaller operation could have been done!
Of course it couldn’t have been that the patient had had uncontrolled diabetes mellitus and hypertension for years on end and was now presenting to the vascular surgeons with basically an end stage disease of infection in a leg with peripheral vascular disease. It wasn’t that the daughter harassed the doctors who had offered a ray amputation at the time the operation was feasible and convinced the mother to reject the operation. It wasn’t that after weeks of non-surgical treatment despite counselling that even an AKA did not achieve adequate clearance of unhealthy tissue.
Hello, people, can we take some personal responsibility for our health here.
Yes, CB thoughts are a concept that was introduced to J much earlier, but it was only in a rotation through General Surgery that the term “CB thought” was taught to him. CB – being an acronym for a vulgar Hokkien term for parts of the human anatomy.
The rule is -
If you think that things will go smoothly, everything bad will occur.
If you say out loud that things will go smoothly, everything bad will occur x many many.
Example 1:
Sitting at breakfast, a colleague in J.’s team looked at the day’s operating schedule and said, “Oh looks like today will be a good day, we’ll probably be done at 3pm.”
DUM DUM DUM!
To put it in a nutshell, a patient proceeded to have severe BGIT requiring urgent scopes etc. etc. and the entire team’s day ended at 8pm.
Example 2:
On call, a senior said, “Tonight’s call seems okay. After this we go and eat prata. Call me when OtherColleague is back from his shower.” and walks out.
DUM DUM DUM!
5min later, the house officer calls J. 2min later, they are resuscitating the patient. 3min later, the senior is leading the resus. 2 hours later, the patient is alive and in the ICU. There was no prata, but there were patients in the A&E begging to be seen.
Yes. As you might imagine, this is not a good thing to be happening. With that in mind, go forth and work! With no CB thoughts.
