In Receiving

The culmination of my final surgical rotation has been a week in surgical receiving.

I like receiving and wish I’d been able to do more of it when I was a fourth year. It’s the best place in the hospital to really really learn. It was where I learned how to take a proper history and was able to practice my examination techniques. It was where I first tried to write in a Kardex. It was where I learned how to do an ECG (note the difference between ‘do an ECG’ and ‘read an ECG’, and that I still can’t do the latter). It was where I got good at doing bloods and cannulas. It was where I had my first try at presenting on a ward round and made a hash of it.

It is also one of the few places in the hospital where I feel that I am doing something marginally more useful than acting as a mini-roundabout for the ward staff, even if that something is only chasing bloods.

I wouldn’t want to do it to the same extent this year, principally because it really does mean doing a full day. In the last two days, I have been on a ward from 12 noon to 8.30pm and from 8am to 4.30pm. It’s great in fourth year. It isn’t my all-the-time priority in fifth year, when the opportunity to escape to the library from time to time is a necessary and precious thing. I’m still glad, though, that I’m getting this week.

Since Tuesday:

  • I’ve got three difficult cannulas, all first time. It doesn’t happen often, but I am quite proud when a patient tells me that they have difficult veins and then I get blood out of them or a cannula into them on my first shot.
  • I have spectacularly failed to get blood from one patient, which led to a double take when he said, “If you want, there’s a good vein in my neck. I can get it to really stand up and then you can try that.” I declined his offer to let me stab him in the internal jugular and went to find a doctor instead.
  • I’ve done my first referral letter, and then I did another one.
  • I clerked in two patients.
  • I presented to the receiving consultant and for the first time ever I felt that I’d done well, even though I still don’t know whether the fact that they always compliment me on my handwriting just means that the content is all a steaming pile of crap.
  • I saw what I thought was a barn-door appendicitis (previously well woman with a one week history of colicky periumbilical pain, localising two days ago to the right iliac fossa at McBurney’s point, associated with anorexia, nausea, vomiting, and mild pyrexia) and then we found out today that it wasn’t an appendicitis at all. It’s an art, not a science. I love it for that.
  • My F1 made me a cup of tea. Twice.
  • I kneeled in a puddle of saline while wearing light grey trousers. You can’t win them all. It dried.
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5 comments

  1. If you’re really wanting practice, and you pay her a lot, T. might let you practice. She’s only had one person hit her veins on the first try, and that was a full-time phlebotomist. She’s even had a neonatal nurse walk away after trying to hit a vein for a half-hour – the woman was in tears, it was so horrible.

    Also: handwriting in the medical field is nothing to joke about. My father is the only one who can reliably read his handwriting. My mother can read it about 90% of the time. Anybody else is just out of luck.

  2. I won’t even ask why there are puddles of anything in the hospital. I just won’t.

    I rescind the above invitation with extreme prejudice. You had your chance to stab a bloke in the neck, and did you take it? No.

  3. The tap on a saline bag had been opened without it being connected to anything. This was discovered only when I kneeled down, in the saline, to insert the thing that it was to be connected to. Believe me when I say that I had worse things on my shoes over the summer…

    As for the bloke I didn’t stab in the neck, I thought that the GMC might object rather.

  4. Oh, using the vein in the neck is a real thing and can certainly be done. It does, however, require that several precautions be taken and is not something that would usually be done for a straightforward blood test and is in any case several light years outside the limits of my competence.


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