The Surgical Reg

This week I have started a new job as a Surgical SpR in a Major Trauma Centre. I was assured by my service manager that I had be allocated a two week ‘shadowing’ period, as I am new to the hospital and therefore have no IT access, badge, any idea how the system works or any experience of working in a Major Trauma Centre. He then went on to say that unfortunately due to a rota gap, there would not actually be anyone to shadow and would I mind awfully holding the trauma bleep. I cannot say I was terribly surprised that, as in most new positions in the NHS, I would be starting very much in the deep end. Shortly after this less-than exhaustive induction, the trauma bleep went off for my very first Code Red trauma call. Time to start shadowing myself! As I couldn’t find my way to the Resus Bay from within the hospital, I walked out of the hospital and came back in the patient entrance to A&E from the street. The patient was just being wheeled into Resus by the Air-ambulance doctor at th...

Squeezing impatiently through the waddling crowd of the unhealthy and the overweight in a hospital's corridors and stairways (and the world in general), it is astounding to remember that that the lifetime prevalence of gallstone disease is actually only about 10% to 20%. It's even more difficult to keep this at the forefront of your mind in a General Surgery outpatient clinic or On-Call, when there is barely a patient who doesn't have abdominal pain that they attribute to their inevitable gallstones! Nonetheless, I assumed that the decision making was a foregone conclusion in these patients who present with typical biliary colic and have proven stones or sludge - of course we should just whip their gallbladder out! Whilst this bit is easy, the practical business of listing a patient for cholecystectomy is a little harder - particularly with the decimation wrought by the COVID-19 pandemic on waiting list times. Patients with uncomplicated biliary colic are extraordinarily fo...