Adios, Surgery

The cruelest paradox of being a junior doctor is that if you should ever be fortunate enough to get all the way through the day with an air of competence and pleasantness and not-entirely-losing-your-mind-ness, it will be for one of two reasons:

1) It is a sign of the end of the world,

or

2) It is changeover next Wednesday.

It was recently brought to my attention that this business of chopping and changing jobs like a toddler with ADHD is not the way of the normal world. I made a remark about the night I’d just had in surgical receiving and I was asked what happened to oncology. And there I stood, befuddled and sleep-deprived, explaining that nothing happened, it’s not that I’ve been getting fired or quitting, thank you very much, but this is, and, oh, yes, I know it sounds crazy, the way that medical training is supposed to happen.

It gives you just enough time to get good at your job, and then the rug is snatched from under you and it’s back to, “I can’t find the venflons/gas syringes/arrest trolley/toilets,” and, “Excuse me, Doctor, can you prescribe analgesia?”/”I can; also, not Doctor, just Beth” and, “What do you mean I’m on call for cardiology?”

Honestly: I thought I’d be thrilled to see the back of this job. I am not a surgeon by temperament or by skillset or even by being terribly interested. It was around this time last year that FY2 jobs were chosen, and when I saw that I’d landed myself with another four months of general surgery I made my Not Impressed Face. A whole career of digging through a lot of mush in different shades of pinkish and yellowish with a patient who for the most important part of our interaction is out cold? (For a given and highly controlled value of ‘out cold’ that doesn’t have me reaching for the emergency buzzer.) It’s not my thing.

And that’s all still true.

But surgical receiving?

That, I’ve loved.

I haven’t even minded that my receiving shifts last upwards of 13 hours. It’s gone fast. Mostly. Except at 10am in the middle of the post-take ward round when consultants who haven’t been awake all night start rhapsodizing about the history of the Glasgow Coma Score. (True story.)

The diagnostic challenge, especially when things are a bit weird. The getting results back and being right, or the getting results back and being laughably wrong and then learning something from that. The coming up with my own management plans and having them actually make a difference, even if the only thing on it that actually made a difference was the morphine. The turning into a slow but reasonably proficient sewer. The having of FY1s, which has not quite stopped being strange but has been an education and has made me realize that I am maybe wearing my grown-up pants more than I think. The slightly bug-eyed (on one of them I was heard to declare that there could be no more patients because between the six of us who were in the doctors’ office in A&E we had treated every single person in Glasgow) but genuine camaraderie of receiving nights. The satisfaction of going off to handover secure and only a little bit smug in the knowledge that the decks have been cleared for the incoming team.

7.56am. The nineteenth patient of nineteen seen and sorted out. Boom.

I may or may not have done a little jig in the lift on my way to the ward round, that morning.

I’ve got five more days of being the surgical SHO, but this weekend was my last time in surgical receiving. I felt competent, I felt on top of things, and at no point did I feel that I might be losing my mind (and it was absolutely not that I had an easy weekend by any definition). I took an FY1 and a bloods folder and did a whole evening post-take ward round on my own. I not only knew where to find the toilets, I directed relatives to them! Contrast this to my first day of receiving in December when the registrar appeared to do the evening ward round and found me swearing at my pager, turning in circles on the spot, and thinking that if the apocalypse came at least it might mean that I wouldn’t have to figure out the inner workings of the admissions board.

At some stage over the last four months, I’ve learned how to do my job.

So, of course, next Wednesday, I have to go and learn how to do a new one.

Because as it was in the beginning, is now and shall be forever, world without end.

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5 comments

  1. …yeah, not that I can at all criticize a system I know not much about, but it does seem a little less …connected than the U.S. system. I think I would run shrieking, flinging bedpans and careening off of walls, to have to start over again so frequently. You’re a trooper, B.♥ Hang in there.

    1. There are advantages and disadvantages to it. North American medical school graduates are expected to make decisions about the shape of the rest of their career a lot faster than British medical school graduates are. I think the extra time is important, and that’s a little bit to do with the fact that medical school works differently here too. I can see where the broad base has been really valuable for me to have, because I’ve done fairly generalist jobs and cancer and surgical problems are things that I’m going to encounter, just by the law of averages, even if I’m not working in oncology or surgery, and I should know how to deal with those things at least a little bit. But I also know that a lot of people have a really specialist experience in their FY2 year and not necessarily in the specialties that are valuable to them.

      The constant feeling of playing catch up, though — yeah, that’s a pain in the ass. I’ve essentially learned how to deal with it at this point. It comes down to, I think it’s good for me but, you know, I also think that Brussels sprouts are good for me.

  2. As for the GCS thing – be grateful you’re not training in Bristol…*

    *home of the Bristol stool chart, for the uninitiated.

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