![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
Entry tags:
I thought it was time for a proper job update
I've been doctoring for almost ten weeks now, and I haven't really posted much about what it's actually been like. Ji said I should make one of those hour-by-hour outlines of a workday, which is a good idea.
This'll be a pastiche of a few different Tuesdays, I think, because that's the day that usually has the most structure.
~
6:00 Wake up. Remember halfway through dressing that I forgot (as usual) to rinse out my portable coffee mug yesterday, and I'll need to run it under the tap before sticking it back in my bag. Juice & yoghurt for breakfast.
7:00 Shove my work shoes into a bag, about to head out the door in sneakers and walk to work.
7:30 Sit down at the computer in the tiny doctors' room on the ward, coffee in hand, to print out my patient list for the day. Discover two new patients in different wards. Race downstairs scribbling out pathology forms on my clipboard to ensure that these patients get their blood taken on the morning blood round. (If the forms aren't in on time, it means I have to go around and take all the bloods myself, leeching precious time from my day.)
8:00 Call my registrar and find out where she is, then do a rapid ward round before her endoscopy list starts. Fill up my printed patient list with lots of little jobs with checkboxes next to them.
9:00 Try to get my consults done early. This involves paging the on-call registrar for whichever speciality you want, then feeding them a concise story about your patient in order to convince them that they need to see them, and then writing that same story neatly in the notes. Easy consults: infectious diseases (I'm good friends with both of the regs by now), surgery (we share a ward with the three gen surg teams, so I can usually do the consults in person if I catch them before or after theatre lists). Hard consults: endocrinology (requires exhaustive knowledge of blood tests), cardiology.
9:30 Paged by a distant ward because one of my patients is complaining that their analgesia is inadequate. Give a phone order for an oxycodone dose, finish ordering all of my radiology requests. Call the radiology reg in charge of CT for the day and convince them that they need to squeeze one of my patients onto their list. Then go down to the ward and chat to the patient in pain before charting some as-needed oxycodone.
10:00 Type up the discharge medications for the two patients we're sending home, and scan them through to the pharmacy. Start typing up the discharge summaries in the vain hope that I'll actually have them ready to go home with the patients. Do this with the phone tucked under my chin, wheedling the on-call anaesthetist into putting a central venous line into one of my patients before the end of the day.
10:30 Paged by a ward pharmacist because when one of the new patients were admitted, one of their medications was charted incorrectly and two of their regular meds were left off the chart altogether. Add to the list. Formally consent the patient who needs a central line and put the signed form into their notes, then go down to write up those meds.
11:00 Paged by the day unit because of the arrival of a woman with chronic liver disease who comes in every week to have ascitic fluid drained from her abdomen. She doesn't speak much English, but she greets me enthusiastically in her own language and communicates through gestures that she needs some more towels. I inspect the procedure trolley to find out what they've forgotten to put on it this week, then fetch the 10mL syringe and the correct size of sterile gloves myself. Insert the drain, tape it in place, sign the order for intravenous albumin, take a sample of fluid and send it to pathology for analysis. Answer the four pages that I received while I was wearing sterile gloves.
11:30 One of the pages was to inform me that a palliative patient with end-stage liver failure has just died. Assure the nursing staff that I'll be up on the ward soon. Poke my head into the endoscopy unit to ask my registrar a series of questions I've been saving up because she isn't contactable by phone or pager when she's doing scopes. Seize the opportunity to have a chat with the IBD nurse about a patient who's going to be referred to the clinic, and drop off a handful of discharge summaries to the receptionist in charge of making follow-up appointments.
12:00 Go to the room of the patient who's died. Explain to the family that I need to do a quick examination, and they're welcome to stay if they wish. They decide to leave the room and make some phone calls. Confirm death by looking at pupils and lack of response to painful stimulus, and listening to the chest for heart or breath sounds. Call the family back in and ask them if they have any questions. Call the consultant and the patient's GP to inform them. Fill out the three seperate forms needed for certification of death.
12:30 Contemplate how long it's been since I've eaten. Get a phone call from my reg saying that one of my consultants is coming onto the ward and wants to round on his patients. Steal a cup of apple juice from the ward fridge to get my blood sugar up a little bit, then gather the notes for the appropriate patients.
1:00 One more discharge added to the list. Quickly send off their meds, after a phone call to my reg to double check how slowly their prednisone dose will need to be weaned. Paged by the discharge lounge to ask me if the summaries are done for my other patients; apologise and say that I'll finish them tonight and mail them out the next day.
1:30 Snatch five minutes to go to the bathroom. Comb my hair and re-apply my lipstick. Feel disproportionately soothed by these small acts. Run down to the staff cafeteria and get some pasta and salad and a Coke Zero. Pager goes off while I am in the queue to pay; answer it on the phone outside the cafeteria. One of my patients is hypotensive, though not having any symptoms.
2:00 Having reviewed my patient, increased the rate of his fluids, and told him to drink more water, I sit down in front of the computer to eat lunch with my left hand and write out the blood results for the day, as well as the next day's pathology forms, with my right hand. Ambushed apologetically by a nurse who needs me to write out a new medication chart for a long-term patient and a medical certificate for a patient being discharged. Chat with the resident on the other gastro team, who's on hold with radiology and looking up places online for us to stay during the weekend winery tour we have planned.
2:30 Go around the wards adding phosphate to medication charts and ordering potassium in IV saline for the patients that have electrolyte imbalances. Stop to chat with a social worker about organising a family meeting, and make sure she's talked to the family of the palliative patient about counseling and funeral homes. Paged to urgently replace a cannula that's tissued, because the patient needs IV antibiotics.
3:00 Tuesday means I have two hours of intern teaching. Call switch and have my pager diverted to my registrar for two hours. Sit down in the auditorium. Body takes it as a sign that it's allowed to try very hard to fall asleep.
4:00 Afternoon tea provided between lectures. Eat a lot of samosas and slices of rockmelon and bits of cheese with crackers. Feel more human. Head into the second lecture and spend most of it checking my email on my iPhone.
5:00 Gastroenterology unit meeting. One of the registrars presents an interesting case and then talks about the condition for a while. I manage to grab the unit head afterwards and get him to sign off my timesheets for the fortnight.
6:00 Drop my timesheets into the box, then go to the cafe and get a chai latte. Put the pathology forms for the next morning's blood rounds in the right spot on each ward. Go back to my home ward to work on my backlog of discharge summaries for a while. Catch the intern working the evening shift and tell them about my hypotensive patient.
7:00 Log off the computer, change back into my sneakers, and call my house to ask someone to pick me up.
~
For the first two weeks, I hated it. Right now I wouldn't say I love it, but I like the ward I'm on and I'm used to the routine and I get a lot of satisfaction from working with patients.
The problem with THAT is that this is my last week on gastro; I'm going to plastic surgery next. I've heard the workload is terrible and you're expected to do a lot of clinics as well as ward work, PLUS spend some time in theatre. I'm determined to grit my teeth and get through it, but I doubt it'll be very good for my mental health.
I will keep my eye on the horizon, the horizon being the two weeks in August when I shall be in BOSTON :D :D :D
This'll be a pastiche of a few different Tuesdays, I think, because that's the day that usually has the most structure.
~
6:00 Wake up. Remember halfway through dressing that I forgot (as usual) to rinse out my portable coffee mug yesterday, and I'll need to run it under the tap before sticking it back in my bag. Juice & yoghurt for breakfast.
7:00 Shove my work shoes into a bag, about to head out the door in sneakers and walk to work.
7:30 Sit down at the computer in the tiny doctors' room on the ward, coffee in hand, to print out my patient list for the day. Discover two new patients in different wards. Race downstairs scribbling out pathology forms on my clipboard to ensure that these patients get their blood taken on the morning blood round. (If the forms aren't in on time, it means I have to go around and take all the bloods myself, leeching precious time from my day.)
8:00 Call my registrar and find out where she is, then do a rapid ward round before her endoscopy list starts. Fill up my printed patient list with lots of little jobs with checkboxes next to them.
9:00 Try to get my consults done early. This involves paging the on-call registrar for whichever speciality you want, then feeding them a concise story about your patient in order to convince them that they need to see them, and then writing that same story neatly in the notes. Easy consults: infectious diseases (I'm good friends with both of the regs by now), surgery (we share a ward with the three gen surg teams, so I can usually do the consults in person if I catch them before or after theatre lists). Hard consults: endocrinology (requires exhaustive knowledge of blood tests), cardiology.
9:30 Paged by a distant ward because one of my patients is complaining that their analgesia is inadequate. Give a phone order for an oxycodone dose, finish ordering all of my radiology requests. Call the radiology reg in charge of CT for the day and convince them that they need to squeeze one of my patients onto their list. Then go down to the ward and chat to the patient in pain before charting some as-needed oxycodone.
10:00 Type up the discharge medications for the two patients we're sending home, and scan them through to the pharmacy. Start typing up the discharge summaries in the vain hope that I'll actually have them ready to go home with the patients. Do this with the phone tucked under my chin, wheedling the on-call anaesthetist into putting a central venous line into one of my patients before the end of the day.
10:30 Paged by a ward pharmacist because when one of the new patients were admitted, one of their medications was charted incorrectly and two of their regular meds were left off the chart altogether. Add to the list. Formally consent the patient who needs a central line and put the signed form into their notes, then go down to write up those meds.
11:00 Paged by the day unit because of the arrival of a woman with chronic liver disease who comes in every week to have ascitic fluid drained from her abdomen. She doesn't speak much English, but she greets me enthusiastically in her own language and communicates through gestures that she needs some more towels. I inspect the procedure trolley to find out what they've forgotten to put on it this week, then fetch the 10mL syringe and the correct size of sterile gloves myself. Insert the drain, tape it in place, sign the order for intravenous albumin, take a sample of fluid and send it to pathology for analysis. Answer the four pages that I received while I was wearing sterile gloves.
11:30 One of the pages was to inform me that a palliative patient with end-stage liver failure has just died. Assure the nursing staff that I'll be up on the ward soon. Poke my head into the endoscopy unit to ask my registrar a series of questions I've been saving up because she isn't contactable by phone or pager when she's doing scopes. Seize the opportunity to have a chat with the IBD nurse about a patient who's going to be referred to the clinic, and drop off a handful of discharge summaries to the receptionist in charge of making follow-up appointments.
12:00 Go to the room of the patient who's died. Explain to the family that I need to do a quick examination, and they're welcome to stay if they wish. They decide to leave the room and make some phone calls. Confirm death by looking at pupils and lack of response to painful stimulus, and listening to the chest for heart or breath sounds. Call the family back in and ask them if they have any questions. Call the consultant and the patient's GP to inform them. Fill out the three seperate forms needed for certification of death.
12:30 Contemplate how long it's been since I've eaten. Get a phone call from my reg saying that one of my consultants is coming onto the ward and wants to round on his patients. Steal a cup of apple juice from the ward fridge to get my blood sugar up a little bit, then gather the notes for the appropriate patients.
1:00 One more discharge added to the list. Quickly send off their meds, after a phone call to my reg to double check how slowly their prednisone dose will need to be weaned. Paged by the discharge lounge to ask me if the summaries are done for my other patients; apologise and say that I'll finish them tonight and mail them out the next day.
1:30 Snatch five minutes to go to the bathroom. Comb my hair and re-apply my lipstick. Feel disproportionately soothed by these small acts. Run down to the staff cafeteria and get some pasta and salad and a Coke Zero. Pager goes off while I am in the queue to pay; answer it on the phone outside the cafeteria. One of my patients is hypotensive, though not having any symptoms.
2:00 Having reviewed my patient, increased the rate of his fluids, and told him to drink more water, I sit down in front of the computer to eat lunch with my left hand and write out the blood results for the day, as well as the next day's pathology forms, with my right hand. Ambushed apologetically by a nurse who needs me to write out a new medication chart for a long-term patient and a medical certificate for a patient being discharged. Chat with the resident on the other gastro team, who's on hold with radiology and looking up places online for us to stay during the weekend winery tour we have planned.
2:30 Go around the wards adding phosphate to medication charts and ordering potassium in IV saline for the patients that have electrolyte imbalances. Stop to chat with a social worker about organising a family meeting, and make sure she's talked to the family of the palliative patient about counseling and funeral homes. Paged to urgently replace a cannula that's tissued, because the patient needs IV antibiotics.
3:00 Tuesday means I have two hours of intern teaching. Call switch and have my pager diverted to my registrar for two hours. Sit down in the auditorium. Body takes it as a sign that it's allowed to try very hard to fall asleep.
4:00 Afternoon tea provided between lectures. Eat a lot of samosas and slices of rockmelon and bits of cheese with crackers. Feel more human. Head into the second lecture and spend most of it checking my email on my iPhone.
5:00 Gastroenterology unit meeting. One of the registrars presents an interesting case and then talks about the condition for a while. I manage to grab the unit head afterwards and get him to sign off my timesheets for the fortnight.
6:00 Drop my timesheets into the box, then go to the cafe and get a chai latte. Put the pathology forms for the next morning's blood rounds in the right spot on each ward. Go back to my home ward to work on my backlog of discharge summaries for a while. Catch the intern working the evening shift and tell them about my hypotensive patient.
7:00 Log off the computer, change back into my sneakers, and call my house to ask someone to pick me up.
~
For the first two weeks, I hated it. Right now I wouldn't say I love it, but I like the ward I'm on and I'm used to the routine and I get a lot of satisfaction from working with patients.
The problem with THAT is that this is my last week on gastro; I'm going to plastic surgery next. I've heard the workload is terrible and you're expected to do a lot of clinics as well as ward work, PLUS spend some time in theatre. I'm determined to grit my teeth and get through it, but I doubt it'll be very good for my mental health.
I will keep my eye on the horizon, the horizon being the two weeks in August when I shall be in BOSTON :D :D :D
no subject
Aaaaaah ok you're a rockstar.
no subject
Your days sound insane. Question: why do you not like surgery (that much)?