Facebook

A few days ago, I gave a general anaesthetic to a young man called Andrew who was having his hernia repaired by the general surgeons. I remember him very well, he was very pleasant and amiable and in the anaesthetic room, he and I chatted for a bit about how long Rafa Benitez was likely to keep his job at Liverpool.
It was a routine operation, and everything went as it should. I went to see him after the operation and he said his was feeling a bit tender, but nothing that a couple of co-codamol tablets couldn’t help with.

The day before yesterday, I logged onto Facebook and I had a message from an “Andrew M” It read:

Thank you for looking after me the other week. I hope you are well

and Andrew M had requested to be my Facebook friend.

I was really touched. It was really nice that he’d taken the time to find out who I was and then written me a thank you message. However, it left me in a bit of a quandary.

Should I accept his friend request or not?

I mulled it over over dinner and then I decided that, pleasant as Andrew M is, I don’t know him. He’s not my “friend” although, I’m sure we could be under different circumstances. And, because I didn’t know him, I didn’t particularly want him looking at pictures of me and my friends or reading what people had been writing about me on my profile.

I clicked “ignore.”

I would have liked to reply to his message with a “Thank-you, I hope you are recovering well” but I knew that if I replied to his message, then the Facebook website would let him see my profile page. I didn’t really want this either, so I clicked “delete.”

Andrew M probably thinks I’m a bit of a fake now and I wish that somehow, I could communicate with him that I was genuinely touched by his message, I just didn’t want him to see the pictures of me from Big Ed’s house party (believe me, they’re not pretty).

What would you have done if you were me?

One thing after another

One of the cornerstones of being a good doctor is being aware of your own limitations and seeking appropriate help as required.

It’s becoming evident to me that since starting on a career in anaesthetics, my job has morphed from “recognising potentially serious conditions and getting help” to BEING the help that people call when things are starting to go tits up (or, more often, when it’s REALLY hitting the fan).

So, today, on the last of my days on call, I’ve been called to help in the treatment of:

A woman in A&E Resus with major trauma who later died on ITU
A woman with severe anaphylaxis who went to ITU and survived and was fine
A woman with a ruptured ectopic pregnancy who survived and was fine
A man who had a cardiac arrest on one of the surgical wards who died
A man with a perforated bowel and multi-organ failure who is holding his own on ITU
Two young people with acute appendicitis who are fine now.

Today has been busy, stressful and I’ve had to be fully focused with one emergency after another, but I did everything that was required of me (and more) and I’ve given my all for the people who needed me.

That said, I’m looking forward to having a few days off to recuperate and to recharge my batteries.

MRI

I've been down to the MRI scanner a few times to help patients and/or the technicians out before and during the scan. Those machines are LOUD and claustraphobic and I can't imagine that having a MRI scan would be in anybody's "Top 10 of things to do this year" list, no matter how neurotic you are.

Every now and then, a patient would come back from the scanner with a slip of paper clipped to their notes saying something like "Patient unable to tolerate scan" or "Patient refused imaging." I'm actually surprised that this didn't happen more frequently.

Surly Girl tells us how much fun it can be:

Giant washing machine thingy? Check. Worrying bed-thing with a knee holder on it? Check. Incipient panic attack? Check. How long will it take? I quavered in Piglet’s voice. Oh, only about twenty minutes, breezed the machine-operator-lady. I was invited to lie down, had my leg immobilised, was given a panic button and some earphones and was shoved into the scanner. Good lord. Because I had to go in up to my chest, the front of the machine was directly in front of my face. Like, an inch away. From a worrying looking slot-thing labelled “Laser Aperture”. Um. Help? Now, although this was better for me than having to go all the way in (a procedure that for me would necessitate sedation, restraints and a scuba tank), it was far from ideal. Far. From. Ideal.

There then followed an endless twenty minutes of staring at the ceiling, trying to keep breathing, and being subjected to the sort of noises that would have confessions from every last inmate of Guantanamo Bay after three minutes. I mean, the noises!! So loud!! Big clangy ones. Horrible headfuck buzzing ones. Weird oh-my-god-what-was-that ones. It was as much as I could do to stop myself blurting “Madeleine McCann has been in my understairs cupboard all along!” in an effort to make them stop.

Lather... Rinse... Repeat...

Wake up… Go to work… Work… Come back from work… Go to bed... Wake up... Go to work... Work… Come back from work... Go to bed... Wake up… Go to work... Work… Come back from work… Go to bed… Wake up… Go to work… Work… Come back from work… Go to bed…

After a while, working 13hr on-call shifts starts to grate…

Dear Medical Students

Dear Medical Students,
I'm not ignoring you, honest. It's just that you always seem to pitch up when I'm covering emergenby theatres and I'm concentrating all I can on keeping the patient 1. alive and 2. asleep. I may be able to give you few factoids or pointers every now and then, but I appreciate that this isn't much use to you when you don't have a good grasp of how anaesthesia affect human physiology. Come back when I'm doing a day case list where the patients are healthy and I'll be able to talk to you more then and teach you about the practical stuff.
I know it's dull/depressing/annoying being asked to stand in the corner and watch when you're not really sure what is going on, but with me, when I'm doing emergencies, that's the way it's got to be. It's nothing personal, it's just that if I let my attention wander away from my patient, bad things can happen.
I hope you understand.

Yours,
Dr Michael Anderson (junior doctor)

Politics

The more time I spend in theatres, the more I become aware of the sheer amount of politics that is going on all around me. In many ways, it’s a very strange environment because there are lots of different factions, each with their own role.

We have (in alphabetical order so no egos get bruised)

The Anaesthetists
The Managers
The Patients
The Surgeons
The Theatre Nurses, ODPs and support staff
The Ward Staff

And then there are lots of other people who you’ll often see down in the theatres such as parents of child patients, radiographers, translators, medical students and nursing students.

The things is, unlike working on a normal ward, I don’t get the impression that anyone is actually in overall charge. I’m pretty sure the surgeons, anaesthetists and managers each think they’re in charge, but none of them are really. All of the aforementioned groups are convinced that they are doing things in the best interests of the patients, but each will have their own perspective. Each has their own agenda and this frequently leads to friction and arguments.

When certain things go wrong, (please note that I’m talking about stuff like time-delays and work distribution rather than direct patient care) then one or more of the factions will start bitching about one or more of the other factions and how they’re “compromising patient care.” It strikes me that no one really sees the big picture. You’d think that the managers would be in the best position to see the “big picture” but the irony is they are they very group who never actually see the patients – and from some of the things they do, this is all too obvious.

Is there a doctor in the house?

I wrote before about the bizarre state that we find ourselves in regarding staffing. Despite the ridiculous shambles of MMC 2007 that left the majority of junior doctors in specialist training either displaced or unemployed, we now find ourselves in a position where there aren’t enough doctors in the hospital to staff a rota.

The situation has now been picked up by Channel 4 and The Telegraph (the BBC, as always remain silent).

Junior doctor jobs are vacant, and trusts up and down the land are having to scrabble around to find emergency locum appointments at the cost of thousands of pounds per week.

The situation is getting worse and worse on almost by the week. Doctors are completing their training and are taking up consultant jobs, taking a break or going to work elsewhere and, because or MMC, NewTown NHS trust is not able to replace them until August.

This means more positions are being left vacant, more pressure is put on the remaining doctors to do the work and the NewTown NHS Trust is having to fork out more and more money to pay for locums to cover the shifts.

To put into perspective how bad things have become, in February 2007 (pre-MMC) there were 12 junior doctors (SHOs) on the anaesthetics rota at NewTown Hospital, today, there are five. Five doctors are doing the work of twelve.

This is obviously unsustainable and in reality, it’s meant that the consultants are doing many of the duties previously done by the juniors. This is good in that the work gets done and our patients don’t suffer delays or poor treatment, but you have to ask; is paying locums and consultants to do the work of junior doctors a sensible use of resources?

I think not.

My colleagues in general medicine and surgery say the situation for them is very similar.

Once again, I’ll say that Liam Donaldson has a hell of a lot to answer for.

Happy St. Valentine's Day

I saw this the other day and it made me smile...

Gossamer Thread

I was speaking to one of the other new anaesthetists the other day and we were discussing how the job was going. She said that we are now in the “danger period” in that we are good enough to be allowed to do things by ourselves and the consultants are happy enough for us to get on with our jobs without having to look over our shoulders the whole time. At the same time, we’re not good enough to be able to cope with every eventuality. The thing about anaesthetics is that when things go bad, they go VERY bad, VERY fast. I think what happened today just highlights this.

I was covering emergencies today and I get a call from one of the surgeons saying they want to operate on a patient from the Intensive Care Unit. When I go and see this woman, I find out that she is very sick indeed. She is in respiratory failure, kidney failure, she has septic shock and has just had a heart attack. The surgeons want to operate because they think her bowel has died.

The poor woman was on death’s door. I spoke with her and she realised that there was a good chance she may never wake up from my anaesthetic and she may die shortly after surgery.

“But what choice do I have doctor?” she rasps at me in a broad Irish accent. “It looks like I’m going to die anyway.”

It never seems to surprise me how some people can face their own mortality in such a calm and accepting manner. I concede that what she says is absolutely true. I give a terse smile and go down to prepare the operating theatres.

There was no way that I was going to anaesthetise this woman by myself. I know my limits. Yes, she’s clinging on to life by a gossamer thread. No, I’m not going to the person who cuts that thread and finally kills her. The ITU consultant, Dr Jones comes down with the patient and supervises me through the anaesthetic and the operation.

Mrs O’Kelly arrives in theatre and we get her on the operating table and I get ready to put her to sleep.

The last time I was in a situation like this, I coped. Things went well, the patient was alert and lucid after my anaesthetic and I went home feeling dead proud of myself.

This time, it was very different.

I’m not going to go into too many details, but Mrs O’Kelly very nearly died in front of me. I couldn’t cope. I could tell she was dying as well. She went from being pink to purple to blue to grey over about thirty seconds. The alarms on my anaesthetic machines were making all kinds of noises that I’d never heard before (and never want to hear again) and, I tried my hardest, I really did, but I couldn’t stop Mrs O’Kelly’s demise.

Dr Jones stepped in and took over and, thank God, she was able to rescue the situation.

I know that, had I been by myself, Mrs O’Kelly would be dead by now and that’s a horrible thought to have.

I love my job, I really do but at times like this I wonder if I’m really cut out for it. I’m not sure I could deal with people nearly dying in front of me every time I go on call. I think the pressure would get to me eventually. One of the theatre nurses once told me, "Michael, you worry too much" and I think he is probably right.

At this stage in my career, I can’t help but feel that sooner or later, somebody is actually going to die and it’ll be all my fault. I really don’t think I could cope with that. I’m not sure I could deal with that feeling.

I don’t think I’m that strong.

New Shoes

When I arrived at NewTown Hospital, I was issued with non-static shoes to wear in the operating theatres. As an anaesthetist, I don't have to stand up for hours and hours at a time, so although they're not being the most comfortable things I've ever slipped my feet into, I have little cause for complaint.

Except for one thing. The shoes have no backs, so they're more like slippers. As you can appreciate, slippers aren't designed for running in, but this is fine because I never have to run anywhere, or do I?

-----------------------------------------------------------------------------

I was on call yesterday and I was on the phone to one of the surgical doctors when the cardiac arrest pager went off

"Cardiac Arrest, Ward A2. Cardiac Arrest, Ward A2"

I groaned to myself because ward A2 was right at the other side of the bloody hospital. NewTown Hospital is pretty big, so I estimated that I had about a 2 minute run ahead of me.

I quickly hung up on the surgeon and broke into a jog and soon I realised my error. I was wearing the standard-issue theatre shoes. In order to move at any sort of speed whilst preventing them from flying off my feet, I had to do a sort of run that was part lunge, part shuffle and part waddle. To cap it all off, the only scrubs (theatre clothes) available today were size XXL, so I was trying to waddle with one hand gripping my trousers to stop them falling down. I can tell you I was got some strange looks as I passed the canteen.

Luckily, by the time I arrived on ward A2, the medical team had managed to save the patient and my services were not required. As I wandered back down to the operating theatres I made a note to myself to always, always, always wear my own trainers to work when I'm on call

- Michael

Hypocrisy

"Have you seen this?"

Dr Ahmed, my supervising consultant for the day, is waving a copy of today's Times. On the front page, the main headline reads, "NHS closes its doors to foreign doctors"

Now,I don't usually write about political things in my blog but, I'm just going to point out one thing.

The British medical profession encourages foreigners to sit British post-graduate exams. this is so in can pocket thousands of pounds worth of exam fees from each doctor. At the same time as we are taking their money, we are now telling them they can't work here.

Isn't this more than a little hypocritical?

- Michael