Emergency Surgery – First Day
I.I.I
FIRST DAY
Emergency surgery… my first rotation ever. Ah, what a time that was. One of the best and worst periods of my life, I gotta say.
After two weeks of shadowing the other house officers and trying to learn as much as possible about how the hospital works, it was finally time for them to move on and for me to step up. Fortunately, I’d be sharing this role with another doctor – a charmingly beautiful lady from Kuwait who’ll go by the name of Valentina for the sake of anonymity. It felt like such a relief being able to split the burden with another junior doctor.
Especially since we had been told our consultant, Mr Moody, suffered from terrible mood swings and was known to have bouts of sexist flare-ups. Then there was Zoltan – the close-to-retiring Hungarian resident specialist who was mostly useless in terms of medical knowledge and spent much of his time in the operating room, Melissa – the higher specialist trainee that is widely regarded as the glue holding everything together, and Mark – a newly appointed basic specialty trainee whose confidence was still shaky at best.
After parting ways with our predecessors, who by then had also become our mentors, it was now our turn to carry the weight of the firm. Being a junior doctor does not mean being useless. Most of the day-to-day work actually fell into our hands. Writing notes, doing consults, booking investigations, discharging patients, taking bloods and inserting intravenous lines (IV) – you name it, it was us doing it. The seniors wanted things done, regardless of who did them or how – which, in a way, is exactly how we’d be pushed to learn.
To that end, I tried my best to get up to speed before we were thrown into the deep end. This, the previous house officers had warned us, would be paramount – especially given our current predicament.
Turns out Mr Moody expected his juniors to know everything about the patients – mostly so he wouldn’t have to. Surgeons, am I right? But honestly, I didn’t mind. I wanted to be the kind of doctor who knew everything about his patients regardless. Being up to date and knowing your patient inside out is an essential part of patient care – even if it means running the extra mile and sacrificing more than most would deem fair. Anything less would reflect poorly on any physician, I figured. That was the standard of practice I had envisioned for myself. That was the bare minimum required of doctors.
And so, on my very first day, I wasn’t anxious so much as I was confident. Over the previous two weeks, I had studied my patients’ conditions and practically memorised their bloodwork and lab results. I knew why they were there and what had been done for them. And when Mr Moody asked for the most esoteric details, I had the answers right off the bat, without so much as an “uhm”. As proud as I felt in those moments, I quickly realised this was simply what was expected of us. There were no gold stars or brownie points for that – I was just doing my job, living up to the absurdly high standards set by those before me.
Fear, undoubtedly, is the main driver here. In hospital – especially in surgery – excellence is the only acceptable yardstick. Failure is not an option, even when it comes to the most trivial, inconsequential details.
If you don’t know something about a patient, your consultant won’t reassure you that it’s fine and that you can look it up later. No chance. They’ll call you a neglectful idiot for not having written it down. They’ll remind you of the grave repercussions that could arise from a single oversight. They’ll give you that look of disappointment that signals you’ve lost their trust. And on a particularly bad day, they’ll turn purple and yell your head off without any chance of redemption. That’s how it’s been since the so-called golden age of medicine – or so we were told. “Tuck your tail between your legs and just take it” was the advice most seniors gave when you started out.
Of course, I’d never be in that situation. Until Mr Moody asked me about one patient’s haematocrit – the percentage of red blood cells in the blood volume. I had come in two hours before the ward round and meticulously written down all the values we usually care about, deliberately omitting those we typically don’t. Unfortunately, this particular number happened to be essential for the newly anaemic patient we started with. I glanced at Valentina, who had also omitted it, and as Mr Moody’s face contorted into a post-tequila-shot grimace, I knew we were done for. Luckily, Melissa intervened on our behalf, and the malicious glint in the consultant’s eye dulled before he had the chance to explode.
It was a close call, but at least I knew someone had our backs. Still, I didn’t want to rely on that safety net. I had to be at the top of my game at all times. No more close calls. No more near misses. No more mediocrity. Just excellence.
The rest of the ward round passed without incident, aside from Valentina and me learning how to locate and lug around all the patient files. Seeing us flustered, the nurses running the ward stepped in to help.
I have to admit that at this point, I felt quite disheartened. Somehow, against all odds, I was keeping up – on my very first day. Only there was no show of gratitude or respect at any point in time. When you see a senior doctor standing idly by while you’re going crazy trying to do everything all at once, it kinda makes you question their humanity. Is holding a patient chart beneath a senior doctor’s paygrade? Is repeating whatever they’ve just dictated too much of an inconvenience? And god forbid you ask them for an extra second to get your crap together.
I think that’s why nurses are often referred to as the beating hearts of the hospital. In fact, this one nursing officer who came to help us reminded me of Carla from Scrubs when she took JD under her wing. In this situation, I was definitely Bambi. I was the clueless intern. I was the one flailing. And I sure as hell needed all the help I could get.
We covered about fifteen patients in under an hour. After that, the rest of the firm headed down to the operating room, leaving Valentina and me to our own devices.
Given Valentina’s language barrier, I was assigned tasks requiring more communication – which, in practice, meant almost everything. From consults and investigations to speaking with patients and relatives. And while these tasks may sound simple, they’re anything but, given the sheer bureaucracy and constant technical failures plaguing hospital systems. For example:
- Ordering investigations: You find a vacant computer and sit down. You sign in – which takes a minute or two – and then you log in to the software – another minute or two. You find the patient, find the test you want to order, write down the indication for it and then submit the order. If you need to print a label, odds are that the label printer is not working – meaning you have to find a different computer and start the process from scratch.
- Sending blood samples: We have a very convenient pneumatic tube system that sends the samples straight to the lab. Only this system malfunctions more often than not. Sometimes it’s not running and sometimes the samples get lost – meaning you have to redraw blood from the poor patient.
- Vetting a scan: After submitting a request on the hospital system, you then check the on-call roster to find the radiologist. You page them. They don’t reply. You call them directly and get yelled at for not paging first. With a million other tasks pending, politeness becomes optional, so you take it on the chin. Then you make your case – essentially repeating everything you already wrote. They either accept the request or refuse it, at which point you mention that your consultant insists or that they’ll be responsible if something’s missed. And even then, it’s on you to make sure the patient actually gets the scan. If transport falls through or the patient is uncooperative, the blame lands squarely on the house officer.
- Doing a consult: After mastering your patient’s story, you once again trawl the roster to find the appropriate on-call specialist. Their pager number is missing, so you call the operator, who connects you. They’re busy. Or unavailable. They call back minutes later, when you’ve half-forgotten the details while juggling everything else. This is when the hospital hierarchy becomes painfully obvious. They’re way up there, and you’re waaaay down here. You present concisely, answer their questions flawlessly, and acknowledge their corrections. Then you relay the plan to your seniors, who promptly decide to do things their own way.
- Writing a discharge letter: Easy when it’s a same-day colonoscopy – practically a one-liner. But when it’s a patient who’s been admitted for three months and whom you’ve just met? You’re expected to condense three volumes of notes into a coherent summary, all while keeping up with everything else.
Needless to say, Melissa’s pager buzzed relentlessly, much like a spinster’s neglected sex toy. We were still getting the hang of things and we needed all the support we could muster. Despite surgeons’ reputations for arrogance, she was anything but. And thank god for that.
With every patient we’d see, our list of tasks would increase exponentially. Mr X would need an extra set of bloods, Ms Y would need an x-ray, Mr Z needs to be discharged ASAP, and so on and so forth.
It hadn’t been one shift, yet I could already see how patients become a number to most doctors. Be that as it may, I figured I’d have to look at the bigger picture. They weren’t just patients. They were people – people with a story of their own, friends and loved ones. They were in hospital for one reason or another, vulnerable and in need of help – be it medical or psychosocial. And it was the patients themselves that reminded me of that.
Somewhere between chasing lab results and booking scans, there was also an elderly man with a distended abdomen and tired eyes who kept thanking me for things I hadn’t really done myself. When I put in his cannula, he apologised for “being a bother” and asked if he’d be able to eat again soon. I told him we were doing our best to rush his colonoscopy, and he smiled like that was more than enough. It struck me then that while I was obsessing over numbers and expectations, he was going through his own trial.
Later that morning, I went back to see the anaemic patient whose numbers I hadn’t memorised. She looked far less alarming than her bloods suggested – pale, yes, but alert and chatty, asking when she’d be able to go home. Standing there, I realised that even though Mr Moody’s attitude might have been uncalled for, it was all in the patient’s best interest. She must’ve been worried sick as we discussed her blood results using complex medical jargon which she couldn’t understand. When I explained everything in layman terms, she was more than fine to stay in hospital for an extra night. She just needed someone to actually speak to her.
Just before things quietened down, I helped an elderly woman sit up so she could sip some water. She squeezed my hand and said, “You doctors must be exhausted.” I laughed, cause exhaustion felt like a badge of honour by then. But as I walked away, it hit me – she saw me as her doctor, not as a measly house officer, a cog in the system, or Bambi. And somehow, that made the whole day feel worth it.
And just like that, our first day as doctors was over. My first day as a doctor – one I had both anticipated and dreaded – came and went. Against all odds, I made it. I survived.