Head Start
I.I.II
HEAD START
As I figured, my classmates-now-colleagues were pretty much in the same boat. We definitely weren’t in Kansas anymore. Some got off on the wrong foot with their firms, some couldn’t quite find their footing, and some would put their foot in their mouth at every given chance. Basically, feet weren’t on our side when we started off.
But I was unrelenting in my quest to be excellent. Every single day, I’d be on the ward at around six in the morning, doing my so-called ‘pre-rounds’. I’d go over the patient notes, check their vitals (blood pressure, heart rate, respiratory rate, temperature, oxygen saturations and level of consciousness) to see if they were stable, review the results of any investigations we had carried out, document any changes in the patient’s condition, and see whether anything had happened overnight – all the while chatting with nurses. Then I’d go check on the patients themselves, ask how they were doing, and give them an update on their management. Simple stuff that would speed up the ward round, help me get to know my patients better, and, as a bonus, impress my seniors.
Then we’d go around the patients and figure out the next steps in their management – ordering further investigations, adjusting their meds, assessing them for surgery or, hopefully, discharging them. It was around this time that I adopted a clipboard as one of my best friends, allowing me to carry around all sorts of forms and keep track of my ever-growing to-do list. All the while, we’d also have med students tagging along, making us feel like we actually knew what we were doing, whilst reassuring them that we did, in fact, not know our asses from our oesophagus at that point. The rest of the day would be spent running against the clock, trying to check off the ever-accumulating to-do list from ward rounds whilst juggling everything else.
Apart from that, our daily activities would vary from day to day. We’d have pre-op assessment clinics where we’d make sure patients were fully optimised prior to undergoing surgery. A very daunting and frustrating task when you’ve got an endless list of patients on a conveyor belt leading straight to your office, all of them with their own problems that need sorting out. When you start off, having to consult a senior about a medical issue is nightmarish. But practice makes perfect.
And it only took one patient for me to become confident with consults. Mr Gnarly Scrotum came in with… yep, you guessed it – a gnarly scrotum. I’m talking balls the size of a basketball as a result of a massive inguinal hernia, for which he’d be undergoing surgery in a few weeks’ time. During his pre-op, he answered “yes” to every single question I asked him. Hypertension – check, diabetes – check, heart failure – check, asthma – check. You name it, he had it. Liver problems, kidney problems, epilepsy, acid reflux – a walking medical encyclopaedia. Oh, and he had been smoking five packets of cigarettes and drinking two bottles of whisky a day for the better part of forty years. Imagine having another seven patients waiting in line when you suddenly realise you’ll need to consult practically every department in the hospital to get him ready for surgery. The stuff of nightmares.
The sad reality is that patients do end up becoming just a number and a task to be checked off a list unless you actively make time for them. And you do need time to take a proper history, examine them thoroughly, outline their problems, explain what’s going to happen, ask about concerns or questions, and reassure them – which, on most days, is not even an option given the sheer amount of work still pending on the wards.
I remember doing this pre-op for a guy undergoing a colonoscopy – going up a patient’s butt with a camera to see if there are any problems with the gut. In order to clean the bowels, a laxative is used the day before the procedure. A laxative I’d have to prescribe. Only this guy had come in on a particularly busy day and I forgot. You can imagine Mr Moody’s face when all he could see was… well, crap. You definitely cannot imagine his screech though. It would put any banshee to shame.
When the workload is so heavy and there’s no other option but to hurry up, something has to give. Given the choice, we’d rather sacrifice a good ol’ chat with a patient than risk missing out on a crucial step that could have catastrophic consequences.
Then there’d be the endoscopy list. Our firm did colonoscopies and gastroscopies – shoving a camera down a patient’s throat into their stomach. Very fun to watch, not very fun to have (or so I’ve been told).
As house officer, we’d explain the procedure to patients and obtain consent, establish venous access for sedation and anaesthesia, then discharge them and explain the findings once the procedure was done. Sounds simple, though sometimes it could get a bit dicey. As a doctor who had just started out, telling someone they have a very suspicious polyp in their gut is not ideal at all. Years of watching Grey’s Anatomy have undoubtedly helped my communication skills, but I still believe a junior doctor should never be made to break such bad news. Having to phrase things in a way that doesn’t gravely alarm the patient, all the while sounding serious enough to get them on board with further management is not an easy task. After all, communication is an art.
So… what else? Oh yeah. Then there’d be my favourite day – surgery day! Of course, on most days I’d be far too busy to make it down to theatre, but on the rare occasions that I did, it felt like magic.
The first surgery I got to assist on was a sigmoid colectomy on Mr Okay – a fifty-something-year-old who came in to have his colon cancer removed. His response to everything we told him was a simple, “Okay…”. When I scrubbed in for his operation, it was all I could do not to squeal like a preadolescent girl getting her first feathery pen. Being up close to a body cavity, with the smell of blood and guts up my nose, fully gowned up and itching for a chance to do something – be it holding a clamp or suctioning – simply made my day. I felt right in my element.
Which was such a relief. As a med student, I did have a few opportunities to scrub in and I knew I loved it – but being a doctor with actual responsibilities just hits different. Imagine coming this far, always saying I wanted to become a surgeon, only to find out it wasn’t really my thing. I would’ve probably freaked out, quit, and gone to Malaysia or somewhere exotic, spending the rest of my days earning my dough by selling sandals on the beach.
But that didn’t happen. I assisted in a couple of major surgeries and was even allowed to perform some basic local procedures myself, such as incision and drainage of abscesses and some suturing here and there, which, as a house officer, is already a dream come true. That’s the thing with surgery. You get out of it as much as you put in. If you push yourself and show your seniors how eager you are, you’re given opportunities to assist and learn. And my passion was very visible.
Day by day, case by case, the job of a doctor stopped feeling borrowed and started feeling like mine. Somewhere between ward rounds, consults, and the smell of theatre, I realised this wasn’t just a job – it was shaping the doctor, and the person, I was turning into.