The 12 Days of Surgery – Div Panesar

I began life on the wards an exact twelve days before I graduated and received my degree – and so I decided it would be criminal not to take advantage of this literary opportunity and incorporate a most apt and well-known Christmas carol; although the hospital shouldn’t be anyone’s “true love”…

 

On the first day of Christmas Surgery my true love gave to me – baptism by fire and mystery:

 

Ah what a festive atmosphere… All the consultants were away, either at their private practises or at another hospital. The registrar was sick, the clinical nurse specialists were on leave, and the practise nurse had a clinic in 30 minutes.

Ladies and gentlemen on the 30th of November 2016, I was North Shore hospital’s only doctor on urology… It was also my first day as a house officer. I believe the medically correct abbreviation here is FML.

I didn’t quite understand what my job involved, (to be fair I still don’t), and was constantly ringing the previous house officer’s cell phone, who was in a different hospital altogether. Through this fumbling, chaotic mess, I managed to order a blood test for a patient and discover they had a longstanding megaloblastic anaemia. I didn’t yet realise that the best possible action to take in medicine is, paradoxically, no action, and decided the only appropriate thing to do would be to directly ring a Urology consultant and demand an explanation for this patient’s haematological bamboozlings. The conversation when something like this:

“HelloMyNameIsDivI’mTheNewHouseOfficerNiceSorryToBotherYou”

“Oh hi Is everything o…”

“YesEverythingIsFineYourPatientHasAMegaloblasticAnaemia”

Silence

“Um…Kay…So…ShouldIStartThemOnThiamineAndB12And…”

“He’s an alcoholic”

“Yes..?”

“He’s had this for years”

“Yes.”

“He’s fine, send him home”

“…Yes. Home.”

“Yeah so… do the discharge summary… on the computer… write about why he came in and send him home… okay..?”

“Okay.”

“Wonderful, have a good day, byebye.”

“I’m sorry”

“…What?

“IMean…ThanksBye” *click*

Ears burning, I meekly returned to my desk and stared at my hands. Five minutes into the job and my boss has already concluded that I am an idiot.

 

On the sixth day of Christmas Surgery my true love gave to me… a weekend of dread and misery.

 

My first week on the job had been going fine, the job was astoundingly more clerical than what I expected, and I was staying behind a couple hours every day to figure everything out. Thankfully the department came to life and I began meeting people more senior than me, which made it easier to do the thinking – mainly because I didn’t do very much of my own in the first place.

Unfortunately, the specific role I have been assigned this quarter is less clinical than most other house officer jobs, it’s just the nature of things, however my acute and on call days are with the general surgery crew – meaning I go from a job where I have no idea what I’m doing, to another job where I have no idea what I’m doing… except this time people can die if I’m dumb enough.

The entire week had been building up to this and everyone I bumped into would say “oh you’re on call his weekend? Goodness they’ve really thrown you into the deep end haven’t they!” I was on ward calls. Which means I’m sort of responsible for all the surgical wards (except orthopaedics). This is a terrifyingly huge amount of obligation for someone who only recently learned how to spell “choledoc… cholo… gall… choledocolithiasis (YES).”

The jobs I had to do were asinine. Honestly. In total I counted 60 jobs logged at the end of the day, and at least 40 of those were “Please chart IVF. Please chart meds. Please chart laxative. Dr may I please give patient paracetamol? Yes? Ok. Please chart paracetamol…” and so on. I was a computer monkey. Six years of medical school and all they wanted from me was my signature. I quickly realised that the point of being on call is not to bog yourself down with menial tasks – on a busy day there are just some tasks which must be ignored. What you’re supposed to do is recognise who’s legitimately unwell amongst the chaos of afterhours care. In a way, it’s exciting.

Enter Mrs M – a seventy-something lovely old lady with half a lung holding up the entirety of her blood’s oxygenation. Her respiratory system is in and of itself an allegory to the battle of Thermopylae – last stand of macrophages and immune responses worthy of ballads to millennia. This lovely lady came to my attention when she decided to cough up a haemoglobin of 69. “Please,” came the cry “please review this lady as soon as possible. She’s not doing well.”

My reaction to this page was something along the lines of: “Oh no. No, no, no, no I take it back… I take it back please! I’ll just sign your paracetamol scripts! This is too scary!!!”

So, I went to review Mrs M – a lady who had the audacity to be sick on my watch – she had a pelvic collection the size of a small grapefruit that she was presumably bleeding into. How inconsiderate. The poor lady was peripherally cyanosed, saturating in her mid-80s on high flow oxygen, reporting of ever increasing shortness of breath, and exhaling lovely ‘coarse’ crackles that I had shamelessly pretended to hear during bedside teachings at medical school. Honestly, dear reader, as scared as I was in this situation – I was also excited. This was it. This was the doctor thing.

The next hour was a blur of reviews, ICU coordinator calls, and researching how to prescribe haemoglobin. When the proverbial hits the fan, the hospital is incredibly supportive – and nice. Professionalism or whatever just takes over, there’s no time to be silly or have silly things happen. I found zen in the chaos. I became a little engine – a Little Engine that Could.

And she lived! She bounced back from her hypoxic shenanigans to the land of warmth and well-perfusion. I was surprised, well maybe that’s not the right word. Delighted then. I was positively delighted that I’d managed to not stuff things up. Go me!

 

On the eighth day of Christmas Surgery my true love gave to me… a large dose of stark reality.

 

Five days on, then the weekend on acute care, and I woke up on Monday feeling awful. It wasn’t because the weekend was stressful or horrific – the acute weekend job is enjoyable in a strange masochistic way – but it was the prospect of having to do it all again that exhausted me. Sleep deprived and bedraggled, I stumbled into the hospital wondering how long I could keep this up.

I think everyone has a day in the twelve day stretch where they hit a wall, where one struggles to give it all meaning and relevance and find inner motivation to keep themselves going. Sometimes you get lucky, and you skip through it, and sometimes it’s your first week on the job and day eight just plain hurts. I think everyone finds their own way to get over the hurdle, sometimes without even noticing it. For me it was simple – sleep. I slept when I got home from work, and then I slept after dinner. I woke up next and I was fine again, not quite 100% but fine.

Over the next few days – nine, ten, and eleven – I noticed myself losing my empathy. I didn’t quite stop caring, but I didn’t want to do patient reviews anymore. I was content with the desk job – the menial tasks of charting laxatives and fluids. It was simple, I could switch my brain off and just do it. I liked my patients, I really did! Patients are usually lovely – they treat you with respect. They thank you for every little thing you do, even if it’s standing a little to the left so that they can see you better. They know you’re there for them, and for some it means the whole world. It was a jolt to lose that, to lose the empathy, even if it was just for a little while.

You’re in a professional environment though, and so nothing about your outward demeanour changes, or should change for that matter. The professional persona makes it easier to do the jobs you don’t want to do; to have the interactions you no longer want to have. The stethoscope around the neck, the scrubs, the flavour of isopropyl alcohol sneaking into your piece of fruit – they’re all symbols, as much to the one wearing them as to their colleagues or patients – and while the uniform is on, the professional mask is complete. So, I did my job, and nothing changed. Or I pretended that was the case and got away with it.

 

On the twelfth day of Christmas Surgery my true love gave to me… a graduation ball ceremony

 

I don’t know why it came as a surprise to me, but everyone had almost the same experience. Stories of dazed bewilderment as we all settled into our places in the hospital. Stories of some bizarre, some tragic and some heart-warming interactions. Everyone had the same but slightly different work stories, everyone was in the same boat. As gruelling as it can be, you’re never alone in this profession, and if you are – then remember your DR’S ABC – remove the danger, and send for help!

It was amusing that we read the oath and received certificates after we’d already been practising for a couple of weeks. I think for me the strangest thing was realising everyone had friends and whanau. Parents, siblings, and whatever’s had momentarily stopped existing in my mind as a background precursor to the culmination that is the individual that stood before me. Our little bubble of classmates was officially incorporated into the wonderful machine that is society. It was both deranged and humbling to be part of it all. I mean yesterday I was being told off by my high school dean for soldering a calculator to the water tap.

And Today I’m a doctor.

In charge of lives.

And laxatives.

… oh, God what have I gotten myself into