My first day after a very relaxing weekend was a very busy on call shift. A surgical on call shift runs from 8am to 9pm and we are the surgical “take team”. This means we see all the referrals from A&E and GP, and we also attend trauma calls. The team usually consists of an FY1, SHO and registrar. There is also a consultant on call, and all the patients are admitted under them, but they usually cover the emergency theatre list during the day whilst we see the referrals. We didn’t get many referrals in the morning, so I kindly helped out with the normal ward round.
Around midday we got our first trauma call – a road traffic accident. A trauma call is attended by the on call surgical team, orthopaedics and the anaesthetist. I really enjoy attending trauma calls as you usually get to see some pretty interesting stuff, however there isn’t much for the FY1 to do so we’re usually a spare part. This time, however, I was asked to put in a cannula whilst they assessed the patient. It was a very high pressured situation so I got performance anxiety and couldn’t insert the cannula – luckily everyone was too busy to notice and the A&E nurse quickly swooped in to take over! Two months in and my cannula success rate is only about 50% but I’m getting there... I hope!
After the trauma call, the referrals started coming in one after the other and I spent most of the day running around the hospital clerking patients. It took me 2 months but I finally know my way around the hospital. My average step count is about 12,000 per day but today it’s been 15,000. Who needs the gym when you’re an FY1 on general surgery?!
When I started this morning I still hadn’t recovered from the day before, so I decided to quickly get a coffee before I went onto the ward. In our hospital NHS staff get free hot drinks, so you can imagine how many times I go there in one day (hint: at least twice). I’m glad I decided to squeeze in that coffee because today was equally as busy, for some reason all of our patients had multiple jobs that needed to be done. I spent a significant amount of time begging the on call radiologist to approve my CT requests then chasing the results of these scans and updating our registrar who was doing the emergency theatre list. One thing I’ve learnt about being an FY1 is that the bulk of the job is administrative work. You’ll spend a lot of time ordering and chasing scans and bloods – particularly on general surgery. The only time you get to clerk a patient is when you’re on call so I’d recommend making the most of this time – it gives you a chance to practice those communication skills they drilled into you at medical school!
Before I left I sat down and updated “The List”. On our first day the registrar stressed how important it was that the list was updated everyday to ensure the ward round runs smoothly so I make sure to do this before I leave each day! After work a few of us decided to get some drinks to vent about our days. One great thing about being a surgical FY1 is that there are so many of us which is great for getting know one another, and teams often help each other out when it gets a bit crazy!
Today we only had 20 patients on our list, which is pretty average for us! I was the only FY1 in my team today, but luckily I had 2 SHO’s and 1 registrar with me which helped! When you have a good team, it makes a huge difference and can often be the deciding factor on whether you leave on time or not!
Today’s ward round was particularly long; we didn’t finish until around 12.30 pm. By the end of the ward round I was dying for a coffee but I had a meeting about exception reporting with the medical education lead at our hospital. Exception reporting is when you report days where you stay late and log your hours. You either get time off in lieu or paid for those extra hours. Things have calmed down now but there were many many days in the beginning where was I staying nearly 2 hours late every day. I didn’t exception report then, but I’ll definitely start now! Our medical education lead stressed how important this is as I was initially worried that it would reflect badly on me. However she explained that it helps the department identify where extra support is needed.
After the ward round I got started on the jobs, had lunch and then continued with jobs for the rest of the day. At around 4 pm everyday we go through the list again with the registrar and check the bloods for our patients. Today we were a bit delayed so this didn’t happen until 4:30, where we discovered our patient had a potassium of 2.8. We followed protocol but it took about 3 of us to decipher the ECG (TIP: always ask for help!) where we discovered some ECG changes so quickly initiated treatment. The patient was stable so panic over – I made it home on time.
Our team was slightly smaller today but we had the same registrar as yesterday so our ward round was super speedy! I was feeling very pleased with myself, having completed all my jobs by 3pm when I got a call that one of the patients I was looking after had become unwell. She was spiking a very high temperature and vomiting. I went up to see her and quickly escalated to my registrar who came to see her with the consultant. I was asked to take blood cultures peripherally and from the picc line – the latter of which I had never done before. What started off as a very chill day had suddenly become really busy! Before I became a doctor, I was terrified of the idea that I’d have to look after sick patients, but in reality you’re very well supported. I’m the queen of escalating early as I’d rather my seniors are aware of the problem before the patient starts to deteriorate even further.
I left slightly late today but I wanted to make sure my patient was stable before I handed over to the on call FY1 who was covering the wards from 5 – 9pm. I was exhausted when I got home so cancelled my dinner plans (a recurring theme) and instead had a very early night.
The “Friday feeling” doesn’t hit the same when you know you have to work over the weekend! It was a very erratic morning as two separate consultants wanted to see their patients halfway through the ward round. I understand the logic but it usually means the ward round takes much longer than it needs to be! Luckily we were very well staffed so most of were finished by 2pm! On Fridays we usually make sure to write a weekend plan on “the list” so that the weekend team know exactly what to do. When you’re working over the weekend, you usually cover an entire ward so you don’t know a lot of the patients. Therefore, it’s really helpful when there is a very clear weekend plan so you know exactly what the regular team would like you to do. After all the jobs were complete, my team kindly let me leave 30 minutes early so I could rest up before my 13 hour shifts this weekend. Unfortunately, I have house viewings all evening so not quite resting but I’m glad I can leave early for once!
Today was a pretty typical week for me, if I’m being honest it’s been quite quiet! Surgery can be a very busy speciality but I’ve learnt a lot and I’m slowly getting to grips with things! I’m very lucky that I have very supportive seniors and a great team, it makes those busy weeks slightly more manageable!
Written by FY1 (Anonymous), General Surgery, London
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