We're quite worried about one of our patients. Simon had an appendicectomy, but because his appendix burst before the operation and released a lot of pus, his bowel hasn't been working since. His abdomen has swollen, and he's in a lot of pain.
I'm not the one to decide whether we should keep going with Simon's conservative treatment or take him back into theatre for another operation. I went off to find a senior surgeon to review him.
My Consultant, The Mountain Goat, is a short stocky man who leaps up stairs three at a time. He does not tell us where he is going, and he does not look back to check that we haven't lost him. We follow him through the hospital like inept henchmen in a James Bond film.
When we finally catch up with him, the look on his face is clear. To him, we are odious slow toads who are mentally and physically weak. We will never make it to consultants.
My registrar is a Giant. He is a tall man with an easy smile. The Giant was on call today. He made several life-or-death decisions each hour. He is an impressive doctor with a fine CV, charming with the patients, and cool under pressure.
We realised today that he passes wind often. He will happily deny it if there is a consultant around. When the consultant leaves, the Giant admits he has a problem.
We were in the operating theatre when it happened. Like Simon, the patient's bowel had become obstructed, and needed an operation to relieve it. The initial moments were uneventful, but when the Giant released his flatus, the smell was so bad that the other surgeon honestly assumed part of the patient's bowel had died.
As the most junior doctor on the team, I am now blamed for the unsanitary colonic discharges of my colleagues, as well as for administrative and medical mistakes. This is the side of medicine that people don't see. It's why I laughed when a casual acquaintance said that "medicine must be a glamorous career".
None of the junior doctors in my hospital leave on time. We stay late to make sure patients receive the overnight care that they need, and then get discharged when they are ready to go home.
When we are spotted, still at work, we are accused of loitering in order to charge the hospital overtime. Within the next few weeks, we will be asked to sign a form agreeing that our jobs do not require the hours we're currently contracted to.
I quite wanted Simon not to die over the weekend, so I stayed on to make sure he had extra blood tests and that the on-call team knew all about him. I don't feel bad about that, even if it does end up causing a stink with Human Resources.
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A worm's-eye view from the UK's most junior doctor.
Patient details have been changed to maintain their confidentiality
2 comments:
I like the sound of your team :)
Your SR really should get his bowels sorted out, or at least alter his diet. If a surgeon opens a belly and smells faeces, they'll always think of perfed bowel / faecal peritonitis. A reg with bad farts sounds like a colorectal theatre nightmare.
PS If you can't run up stairs three at a time you're a wuss and you'll never make it as a surgeon ;)
HP is always first to the top of the stairs :)
mate, this is a great blog. There's a lot of medical blogs out there, but this one is really well written. Also, very easy to identify with for those of us who've been PRHOs. So, congrats on a super blog, from a fellow newbie in the blogosphere. Keep up the good work.
Dr. Thunder
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