We started with handover, all the Night Shift staff sat with myself and the day general surgery team and spoke through the emergency department intake over the night. They covered approximately 12 cases, discussing symptoms, patient histories, examination patients have undergone and management plans. After the day on call team (consisting of a consultant, reg, SHO and FY1) took notes on all the cases, pagers were handed out and we were off on the morning ward round.
We now started darting from patient to patient in order of importance, where I was practically glued to my FY1’s side. I listened meticulously at each patient consult, which was led by the consultant. The consultant asked each patient questions covering patient history, how they were feeling and discussed with them the ongoing plan of action. I made notes during each patient consultation and on our speed walks between picked Dr Taylor’s brain with questions, on anything I didn’t understand. Dr Taylor was in charge of putting all plans into action, this involved ordering CT scans and blood samples, taking bloods, prescribing medication. Throughout everything he did, he asked me if I understood what he was doing and when I didn’t he explained to me in detail why he made the decision he did.
In the morning we covered how to calculate the amount of IV fluids a person would need and how to decide what type of fluid they need based on whether you need to hydrate intravascular space or intracellular space. We discussed how differential diagnosis’ were made and the management plans that were put in place for the ongoing day for the patient we had visited. Once coming to the end of the ward round the consultant left the hospital, leaving the Reg in charge of the general surgery intakes.
Now was the perfect time to grab coffee before our CT scans came back. We assessed CT scans, many CT scans highlighted diverticulosis, probably the most prevalent cause for people falling under the care of the team I was following today. However, there was one CT that was a black sheep from the crowd, the Reg and Dr Taylor flicked through it, highlighting inflammation around the appendix due to a fecalith blocking the head of the appendix which causes appendicitis. This is something I had covered in my human physiology and medical imaging module in case studies, but was now seeing it right in front of me. This highlighted the importance of pattern recognition in the job. The symptoms, the scan and blood work of the patient all formed the perfect pattern to lead someone to conclude this patient had appendicitis.
Being on call was fast paced and literally changed minute by minute. Rapidly, we now made our way to the OR, so I could get to opportunity to watch an I&D of an abscess. This was the first time I had ever been in an OR, no amount of Grey’s Anatomy on TV and Touch Surgery (a very useful and educational app) prepared me for how exciting and interesting I would find this. Even in this very short lived 25 mins I spent in the OR I was buzzed by the intellect and communication skill that the Reg and SHO showed. I could have stood there all day and watched surgeries for hours on end, mesmerised by everything that happened in there.
After surgery we made our way down to ED to see patients that had come in. Dr Taylor explained to me the importance of taking a patient history. A good patient is the beginning to the detective work in coming to a diagnosis. In general surgery a lot of the time an examination of the abdomen had to be carried out, this is to check for tenderness and guarding, a cough pulse (for hernia’s) and for any internal masses. Finally, if patients had any signs of PR then a rectal examination was mandatory, 80% of colon cancers can be detected in a simple rectal exam, as they are located in the lower portion of the colon, the rectum and the sigmoid colon. After the detective work had been carried out Dr Taylor would come to 1 of 2 conclusions, one- being this is an acute problem and needs to be dealt with today by the general surgery team, or two- a referral to the GP for further investigation. Then he would write up the notes from the meeting with the patient, prescribe analgesia and then decide on management plans for our next course of action.
One of the final patients we saw was in resus, the patient history was long and Dr Taylor spent an extended amount of time reading through everything to ensure nothing was missed. We assessed the ECG to which I identified there was arterial fibrillation (super excited I got that correct) and then Dr Taylor went on the explain the condition that our patient had and the science behind it. This for me really highlight the link between everything I have so far learnt in uni the previous year and how it linked to these clinical cases, he discussed the Frank Starling Curve and how the shift in it was caused. This is when our Reg joined us and discussed that he would be starting 2 types of antibiotics and this was due to antibiotic resistance, and how different antibiotics work on different parts of the cells. Although much of this was complex and somewhat went straight over my head, the fact that I had covered most of this in my previous year in uni and I was now hearing about it all in a clinical setting excited me, and reinforced that I was working in the right direction towards getting to where I wanted to be.
Finally, handover again, we had full circled and now Dr Taylor was the one handing over to the night staff explaining what we had done in the day and what needed to be done over the ongoing night.
After leaving my full-time job 2 years ago to start my journey to Medicine I definitely have days that I panic ‘Have I made the right decision?’, ‘I have 6 more years in education!’, ‘I will qualify after I’m 30 years old’ and I do question if I made the right decision. That is normal I guess when making a big life changing decision, I was in a comfortable full-time job, a manager, on good money and working my way up in the company…For what, all to start back at square one? But today made me realise, when I came to the end of the 13 hours, physically I was exhausted, but mentally I wanted to stay on and do the night shift, I wanted more. For me today was not just work experience that will sit on my personal statement and help me pave a way into med school, today was the reassurance that I made the right decision. The decision to start working towards hopefully one day having a life-long career in Medicine.
