Author:  Angelina Di Re

Editor:  Elizabeth Campbell

 

I wake to the sound of my alarm at 0610 and snooze it several times before finally staggering out of bed at 0630. I’ve never been a morning person, which makes my job as a General Surgical Registrar tricky at times.

I have a quick shower, do my make-up and am out the door at 0650. I make a mental note to wake up 10 minutes earlier next time, so I can have breakfast (which I never do). Luckily, I only live five minutes away from the hospital – I’m currently on a rural secondment for six months so at least I don’t have to deal with city traffic on my drive to work.

I call my husband quickly on the drive over. He’s in Sydney working as a nurse practitioner, and unfortunately not able to take leave from work to accompany me to my current placement. It’s the third time throughout our relationship that I’ve been sent rural, so I guess we should be used to it by now. We chat about our plans for the day – I have an elective afternoon operating list, and will also be the on-call after-hours Registrar tonight.

I arrive on the surgical ward at 0700. My consultant was on-call for general surgical emergencies overnight, and I get a brief handover regarding the new overnight admissions from the night on-call Surgical Registrar. There are patients with cholecystitis, diverticulitis, and an elderly patient with a small bowel obstruction.

I commence the ward round – I only have 14 patients to round on, which is relatively light compared to other terms I’ve done (where it can be upwards of 30 patients). My main concern is the patient with a small bowel obstruction – he is quite tender on examination, and his imaging is concerning for possible bowel ischemia. My consultant joins the round at 0745 and agrees with my concerns, so we book the patient for a laparotomy. I also organise a CT for another inpatient with prolonged post-operative ileus.

We start the laparotomy at 0930. It was a closed loop bowel obstruction from a band adhesion. The bowel was still viable but had we left it until the afternoon, the patient would likely have had necrotic bowel and require a resection. That also means it’s a relatively quick operation, and we are finishing up at 1030.

I then attend the hospital clinic (which I am now running late for). There are 26 patients booked in. Two other Registrars and I see all of them by 1230. Most of the patients are post-operative – we perform wound reviews, remove sutures, prescribe antibiotics, and refer patients to see the surgical consultants if we have any concerns.

The elective afternoon operative list start at 1300 – I grab a quick chicken wrap from the hospital kiosk and make it in time for my list, which consists of a couple of inguinal hernia repairs and a vasectomy. The cases are relatively uncomplicated. However, in between cases I check the CT for my post-operative ileus patient – and it looks concerning for a caecal volvulus (a surgical emergency)! We review the imaging with the Radiologist and the treating consultant, and we book the patient for an exploratory laparotomy. Whilst waiting for theatres to send for the patient, I make sure he is adequately resuscitated with intravenous fluids, adequately consented, I also contact his next-of-kin, and get our stoma nurse to site him.

I take over the on-call General Surgical Registrar phone at 1600, just in time for this laparotomy to start. I am also handed over two appendixes to do tonight, as well as two new consults to see (one in ED and one on the ward) – they are not urgent and will have to wait until in between cases.

We commence the laparotomy. It’s initially a difficult case due to the fact that the patient had a previous operation one week prior for a separate pathology, and there are quite a few adhesions. My consultant is scrubbed in with me due to the potential complexity. We confirm the patient has a caecal volvulus, and proceed to perform a right hemicolectomy. We are happy with the patient’s condition during the operation, and decide to perform an anastomosis rather than giving the patient a stoma.

After we finish the case, I run to ED to see a consult. It is a 30 year old lady with a non-lactational breast abscess. She is clinically well, and easy to sort out, requiring ultrasound-guided aspiration as an outpatient.

I also see the ward consult, an 80 year old lady with multiple medical comorbidities, admitted under the geriatric team with pneumonia. The consult is for PR bleeding from prolapsing haemorrhoids. She is not bleeding when I see her, but will require anaesthetic review and a colonoscopy and haemorrhoidectomy during day hours.

I then head back to theatres to proceed with a laparoscopic appendicectomy, which we begin at approximately 2030. The patient unfortunately had perforated his appendix, so I have to perform an extensive washout to prevent a post-operative collection. During the case, I get called regarding a new ED referral, as well as a call from the ward JMO regarding an unwell ENT patient.

Once I finish the first appendix, I prioritise the unwell ward patient (the ED patient sounds well and should be able to wait until I have finished my next operative case). It’s a post-operative ENT patient who is bleeding on the ward. I initiate first aid, contact the ENT consultant, and sort out an appropriate management plan. The bleeding settles in time for my second appendix, which is more straightforward than the first case. I complete operating at 2230.

I check that the ENT patient and all my post op patients are ok – which they are. Being able to make an almost immediate improvement in patients’ lives is one of the things I love about my job. I then head to ED to see the patient. It’s a 60 year old lady with likely biliary colic. She lives a two hour drive from the hospital, so I admit her for analgesia and an abdominal ultrasound in the morning.

I escape the hospital at 2300; it is offsite on-call until 0700 tomorrow. I haven’t had anything to eat all day except for my chicken wrap. I rectify this by taking a detour through McDonald’s drive-thru. One quarter pounder meal later and I’m a happy camper. I call my husband (who is half asleep) to let him know I’m still alive.

I get home at around 2315, get into my PJs, check the on-call phone to make sure I haven’t missed any calls, before setting my alarm and getting into bed. I never sleep well when I’m on call. I’m not supposed to get called overnight unless it’s a life-threatening emergency, but I still never sleep easily.

I wake up to my alarm at 0530 – I check the on-call phone (no missed calls, phew!) and call the ED to see if there are any new surgical referrals overnight. There are two patients to be seen. So I hop out of bed, head to work to see these two patients, and start the process all over again. I’m glad to handover the on-call phone to another Registrar (we do one 24 hour weekday on call per week, and are on call 1 in 4 weekends).

At the end of the day, General Surgery can be a pretty full-on job, however most subspecialties in medicine are. There is such variety in my job, with never a boring day (no two shifts are ever the same)! I think as long as you love what you do, that you’ll enjoy it.  I know I certainly do.

 

* This is a work of fiction – any resemblance to actual events or persons is entirely coincidental.

 

Useful resources

onthewards podcasts

A career in surgery with Dr Titus Kwok

 

onthewards blogs

Making the cut with Dr Rewa Keegan