The Surgical Reg

The hospital in which I currently work is unfortunately not a Major Trauma Centre, although the head of Emergency General Surgery tells me that the Big Wigs have aspirations to make it one in the next 10 years - so long as Neurosurgeons can be persuaded to work here. Nonetheless, in a typical on-call week you can currently only be expected to be dragged down to A&E once or twice for a trauma call and consequently trauma laparotomies are vanishingly rare! Last weekend however, my Sunday afternoon got a bit exciting! The Consultant was being supportive and hanging around unscrubbed in theatre whilst I attempted a somewhat troublesome Hartmann's for perforated diverticular disease that had been brewing on the ward for a little while before deteriorating that morning. As I was firing the Contour stapler to divide the rectum, the trauma bleep went off, so we sent the SHO off to investigate and the Consultant scrubbed in to help me. Not long afterwards, the SHO called back to excited...

Necrotising fasciitis! Two words that instantly twist the guts of any surgeon with an icy squeeze.  It’s bad enough when the back of your mind whisperingly flirts with the possibility of this dreaded diagnosis whilst reviewing a patient with a perfectly innocent, garden-variety cellulitis in the light of day. It’s a little more troubling when, later that night at 3am, you suddenly sit bolt upright clutching at the damp bedsheets, utterly convinced that somehow you missed the first subtle signs. It is of course worse by far to peek under the bedsheets and instantly just know. For a disease that is supposedly vanishingly rare according to the textbooks, I feel that in my short career I have already encountered more than my fair share. Four cases of barbaric, destructive, ruthless dissection are seared into my memory. The overpowering smell. The sensation of human flesh liquified to a grey soup. The putrefaction of normal anatomy to the point where a deluge of stinking liquid leaks ou...

This may come as a surprise to those who bemoan the stress, unpredictability and long hours, but it was refreshingly great to be on-call last week! Predictably there were frustrations, as I found myself frequently lost in this new hospital, constantly ignorant of how the system works and rather peeved at being left high and dry by a rota gap for the on-call SHO on two days. But in general it was good to be back on the horse, attempting to sift through and make sense of huge numbers of patients with belly pain, vomiting and bleeding that were coming at me from all directions, and trying to determine who needed an operation and in what order. One of the highlights, having just unscrubbed after finishing a particularly horrendous appendix, was a call from obstetric theatres, asking to attend for a woman having a c-section. Scrubbing in, the Consultant Obstetrician had already got into the peritoneal cavity, and was concerned about a small bowel injury. The patient had had previous c-secti...

Since rotating onto this current placement on the first Wednesday in October, I have been rotated only to normal working days. Gone is the previous Rota Master's fickle torture regime of a single night shift followed by a day shift, followed by a night shift madness. Instead, the new Controller of Spreadsheets appears to group on-calls together in a big lump! It all kicks off next week, when I have a week of long days on-calls, followed by a week of nights on-call, followed by weekend of nights, finishing up with a weekend of days on-call!  I have surprised myself with the realisation that I am wholeheartedly looking forward to receiving the bleep on Monday morning?!? Despite the higher possibility of getting a lunch break, the feasibility of using the bathroom when you need to, and the ability to get a decent amount of sleep at night that comes with elective work, I find that I do get tiresomely fatigued with day after day of Multi Disciplinary Team Meetings, ward rounds, outpatie...