On a roll

Now I’ve passed my exam, it means that I’m going to be an anaesthetic registrar in less than a year’s time. This means that out-of-hours I’ll be the most senior anaesthetist in the hospital and have to look after just about everything with no immediate back-up. It’s quite a scary prospect, so for the next few months I’ve decided to try and get as much exposure as I can in the aspects of anaesthesia and intensive care that I feel I don’t have much experience in. Effectively this is just about everything at the moment, but right now I’m trying to concentrate on specific procedural skills, so I’ll feel much more willing to do things out of hours. Specifically, I’m focusing on spinal and epidural anaesthesia.

This is one of the many aspects of anaesthesia that I find truly amazing. Basically, with an injection in the back, patients can have their operations and be completely awake and lucid throughout. You can sit next to them and have a conversation about gardening whilst they have their leg sawed off or their womb sliced open and they are completely pain-free throughout the whole operation. It’s really quite incredible if you think about it.

I know this link makes it look very simple but actually giving the injection into the right place is very tricky though because you can’t see where your needle is going. I have to rely on my knowledge of anatomy and previous experience to get it right.

A while ago, I posted about having a bit of a crisis of confidence. I basically felt that I wasn’t as good as I’d have liked to be at some aspect of my job. Well, it’s now a month later and I feel rather different, I've got over myself a bit and now just want to get as much experience I can at stuff so I can get better at it.

I clearly remember being a house officer in my first few months of my medical job. We had an elderly gentleman, Mr B., on the ward who had terminal cancer. He needed a venflon so we could give him some IV fluids to prevent him getting dehydrated. I tried once; I failed. I tried again; I failed. I must have looked really dispondent because he said to me, "Son, if you fall of a horse, the first thing you must do is get back on it again." The third time, I succeeded in getting a venflon in. Unfortunately, Mr B died of his cancer a couple of weeks later, but his words have stayed with me to this day.

A couple of months ago, I often just could not do spinal anaesthetics. I’d attempt and fail and then have to ask the consultant or registrar to take over. In the last few weeks, however, I’ve got much better at it. All of my last five attempts have been successful. All five patients had no pain for their operation whilst being awake. I’m on a bit of a roll and am feeling a bit pleased with myself at the moment.

On another note, I feel that my getting the exam out of the way early is going to be really beneficial for me. Now, I really do feel like all the pressure is off and I can get on with the business of learning to be a really good anaesthetist. Also, from a career point of view, it gives me time to get involved with audits and teaching. This is good because I really enjoy teaching and it will look good on my CV. All-in-all I feel that for the next few months, at work I can relax a bit and really start to enjoy myself.