In a way it feels like we've been doing this forever but really we (and our patients) have survived just 3 weeks on the wards! I feel like the learning curve is still almost as steep but certainly we are also getting to grips with the daily tasks we need to perform. At least when we are asked to do something, you feel less like a rabbit standing in the headlights of multiple Landrovers... initially each day of work felt like a 12-hour long exam!
I myself have done days on call, anaesthetics shadowing, days managing the surgical high dependency unit, a week of nights and now am what they call the "twilight" down South or the "backshift" up here. (They have their own terminology for a LOT of things.)
Working in such a big unit means we are rotated through all these different positions which enable us to pick up a broad range of skills. HDU and nights you are less (but well) supported and are expected to assess unwell patients on your own. Of course at first this is daunting especially when people are very sick, but everyone has to start somewhere and as I say though there are fewer seniors to call, they come quickly when you need help. This is particularly important at night time where we are essentially the only person on the ground for about 150 surgical patients. In fact, what I've found surprising is I have enjoyed these experiences more than the "day job" where as a junior there is a lot of administrative paperwork to do - the discharges, the booking of procedures or investigations, and the odd clinical tasks but very little of the thinking that you train for so many years to do!
There have been lower points too - I've definitely sampled the blood, sweat and tears of the job with much more of that to come, but in any job this is to be expected. Mainly this derives from I guess the high expectations from the team and patients, and yourself. But it also drives excellent care of which I'm pleased to say I believe my hospital delivers on. It's Edinburgh's second largest unit - one of two teaching hospitals, and is the slightly older one - less modern and more humble and unassuming but people work hard and really know their stuff. Staff from all areas are also generally very friendly which makes a big difference, from the seniors (generally!) to nurses, support workers and the tea ladies.
So really, whilst the hours and the work is testing at times, I can't complain too much ;)
Wednesday, 27 August 2014
Friday, 8 August 2014
48 Hours as a Dr
Day 3 into the job and I'm tremendously grateful for a day off already!
My first two days involved me being "on call" - when you care for patients who come in acutely unwell. My schedule said I was to be in 0745 - 2010. It was in reality 0730 - 2215 both days!
Day one was a bit chaotic, as you might imagine. The day always starts and ends with a ward round - usually about 2 hours each, followed by the jobs that need to be done. My partner and I had had a practice run ward round the day before so we knew roughly what was expected. It was passable just about and since it was day one, the team went a bit easier on us. We then spent the morning figuring out how to do a discharge summary on the IT system (despite having had the training the day before!) whilst being harassed left, right and centre to discharge as quickly as possible, oh and this cannula, that ECG, this fluid chart, this review, oh and you need to do this now too etc etc! I didn't drink a drop from when I left home in the morning until 10pm that evening. But I didn't once feel I needed to either! Adrenaline does crazy things to the mind.
Day two was.. also chaotic! But in a different way. We knew what we were doing, but this time we were cut no slack. The list hadn't been updated because the second year doctors didn't know they were meant to. There were three students determined to stick with us (I now understand why students are not looked kindly on all the time!) The caseload that came in was also complicated - patients with multiple co-morbidites and therefore you have to keep a close eye on. They often say the most difficult thing as a junior is understanding when to escalate for help. I can now most definitely relate to this!
I remember at one moment standing in front of the computer at the nurses station, thinking, whoa I am juggling so many tasks. It was a strange feeling being halfway through so many things but not able to complete many of them as they were waiting on something else like a blood test to come back, or a nurse to come off their break. Prioritisation is a skill I need to develop! As the day went on, I never felt like I was flagging but I was aware it was highly unlikely even at the pace I was going I would be able to complete everything by the evening ward round which was to start at any time the team saw fit!
The moment came far sooner than I had hoped. The team literally appeared in front of me as if from nowhere and we were off. The other junior had no idea we had started and hence was on another ward. This was not the sort of time (when you're balancing three files and three obs/drugs charts) when you could phone! I trudged on, I think slowly becoming more and more frantic within myself. It didn't help the notes were scattered across the ward as the nurses had been giving out the evening medications. There was a lot of running around, scribbling, picking up dropped files, muttering of results and the occasional glare when something wasn't quite what they wanted to hear. (It's as if by magic we're expected to know how things operate in the hospital having not been told!)
We just about finished and I found it all a bit overwhelming. The team told us to complete jobs and meet them on a different ward. They left, and I couldn't help but well up. It was relentless and I felt I hadn't demonstrated how much work I'd put into the day to get everything done. But you live and learn!
We ended up staying another 3 hours to finish all the tasks that were left, before a much-needed debrief on the way home. All's well that ends well.
Here's to the learning curve getting less steep..!!
My first two days involved me being "on call" - when you care for patients who come in acutely unwell. My schedule said I was to be in 0745 - 2010. It was in reality 0730 - 2215 both days!
Day one was a bit chaotic, as you might imagine. The day always starts and ends with a ward round - usually about 2 hours each, followed by the jobs that need to be done. My partner and I had had a practice run ward round the day before so we knew roughly what was expected. It was passable just about and since it was day one, the team went a bit easier on us. We then spent the morning figuring out how to do a discharge summary on the IT system (despite having had the training the day before!) whilst being harassed left, right and centre to discharge as quickly as possible, oh and this cannula, that ECG, this fluid chart, this review, oh and you need to do this now too etc etc! I didn't drink a drop from when I left home in the morning until 10pm that evening. But I didn't once feel I needed to either! Adrenaline does crazy things to the mind.
Day two was.. also chaotic! But in a different way. We knew what we were doing, but this time we were cut no slack. The list hadn't been updated because the second year doctors didn't know they were meant to. There were three students determined to stick with us (I now understand why students are not looked kindly on all the time!) The caseload that came in was also complicated - patients with multiple co-morbidites and therefore you have to keep a close eye on. They often say the most difficult thing as a junior is understanding when to escalate for help. I can now most definitely relate to this!
I remember at one moment standing in front of the computer at the nurses station, thinking, whoa I am juggling so many tasks. It was a strange feeling being halfway through so many things but not able to complete many of them as they were waiting on something else like a blood test to come back, or a nurse to come off their break. Prioritisation is a skill I need to develop! As the day went on, I never felt like I was flagging but I was aware it was highly unlikely even at the pace I was going I would be able to complete everything by the evening ward round which was to start at any time the team saw fit!
The moment came far sooner than I had hoped. The team literally appeared in front of me as if from nowhere and we were off. The other junior had no idea we had started and hence was on another ward. This was not the sort of time (when you're balancing three files and three obs/drugs charts) when you could phone! I trudged on, I think slowly becoming more and more frantic within myself. It didn't help the notes were scattered across the ward as the nurses had been giving out the evening medications. There was a lot of running around, scribbling, picking up dropped files, muttering of results and the occasional glare when something wasn't quite what they wanted to hear. (It's as if by magic we're expected to know how things operate in the hospital having not been told!)
We just about finished and I found it all a bit overwhelming. The team told us to complete jobs and meet them on a different ward. They left, and I couldn't help but well up. It was relentless and I felt I hadn't demonstrated how much work I'd put into the day to get everything done. But you live and learn!
We ended up staying another 3 hours to finish all the tasks that were left, before a much-needed debrief on the way home. All's well that ends well.
Here's to the learning curve getting less steep..!!
Tuesday, 5 August 2014
The ultimate test
Tomorrow we are officially working doctors! It's a scary, scary thought. So scary that last night after one of my new flatmates poured out his fears, I realised, for once, I too was more scared than I had realised. Consequently I got very little sleep and ended up walking all the way to the hospital this morning as I had left so early.
It was a busy morning but I'm grateful my partner-in-crime and I at least had a practice run racing after our team lead who was working at absolute lightning speed. All the stories you hear about juniors simultaneously juggling notes/obs files/clipboards/themselves are true!
I'm determined not to make tonight another sleepless one so time for a bit more last minute revision (where a syllabus when you actually need one?!) before my last night as a junior doc who can pretend they aren't actually one at all!
It was a busy morning but I'm grateful my partner-in-crime and I at least had a practice run racing after our team lead who was working at absolute lightning speed. All the stories you hear about juniors simultaneously juggling notes/obs files/clipboards/themselves are true!
I'm determined not to make tonight another sleepless one so time for a bit more last minute revision (where a syllabus when you actually need one?!) before my last night as a junior doc who can pretend they aren't actually one at all!
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