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...

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...

I have been on-call this weekend. For the most part, it has been a dreary affair, with the ward round of the 40-odd surgical patients interspersed only with popping an abscess or two, and trudging to A&E to see the next non-specific abdominal pain that they're not sure what to do with. Fortunately however, the next phone call was a referral for a  74 year old gentleman presenting with abdominal pain, distention and vomiting. The CT demonstrated a closed loop small bowel obstruction, with venous congestion of the affected loop. I got on the phone to the anaesthetist and theatre co-ordinator to give them the good news. As it was Sunday, and my consultant had only popped in to be briefly acquainted with the new admissions so as not to fall foul of Trust Policy, I let him know what I was up to when the ODP was on their way to retrieve the patient from A&E. Once the anaesthetist had done their bit, I carefully examined the relaxed virgin belly, attempting to palpate anything tha...