I notice as I walk across the hospital car park that my initial anxieties about becoming a registrar are slowly easing away. I’m week three into being a registrar and it’s already a far better job than being a house officer.
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Today’s agenda: theatre in the morning with my clinical supervisor, followed by outpatients clinic in the afternoon. Oh, and I’m also the ward registrar today and first port of call for the juniors’ questions regarding ward patients.
I get to pre-assessment at 7.45am and check the list: two inguinal hernias and a laparoscopic cholecystectomy (lap chole). Great stuff – bread and butter general surgery.
First challenge – to find a free computer to look up letters and blood results (a good registrar probably would have done that yesterday evening!).
Second challenge – finding a marking pen! (A good registrar would have one of those ready too!) By 8.15am I’ve consented and marked the patients, and as I’m heading back to theatre I’m met by my consultant who’s impressed by my efforts. (Get in!)
I lead the briefing and remark to myself how funny it feels for me to be the one asking for equipment instead of a senior! Challenge of the day is the lap chole who has a BMI of 45 and previous perforated appendicitis as a child… we all ponder how long we’ll spend dividing adhesions and if our equipment will reach adequately!
Working with Patients
I’ve got 15 minutes now before the patient’s on the table…
As I arrive at the wards there’s two consultants with a junior each seeing their own patients. I attempt to mop up the rest with a friendly SHO. Thankfully she knows all the patients backwards which makes reviewing so much easier.
One concerning patient is a 64 year old gentlemen who is day five post right hemicolectomy who hasn’t opened his bowels and is tender on the right hand side – worse than yesterday.
I advised to get some up to date bloods and a CT scan to rule out our biggest concern: anastomotic leak. I ask the SHO to book and chase the scan report and to let me know once it’s done.
Working with my Consultant
I head into theatre as the patient’s being wheeled in from the anaesthetic room (pure luck!) and scrub for the first hernia. My consultant lets me do the case… as long as I don’t take too long! Luckily it was a nice and straight-forward one with a small direct hernia.
Second one was slightly trickier – a large inguino-scrotal with a huge indirect sac. My consultant gave me some good pointers and I finished the case myself, if a little slowly.
He reassures me that I’ll get quicker and that I did well to fix that hernia myself… which makes me feel better. Final case on the list starts at 11.45. Anaesthetist politely reminds my consultant that he has a meeting at 13.00 (read: don’t let your registrar take too long with this one!)
I initiate pneumoperitoneum and as expected, we find some right-sided adhesions but he clears them easily enough and cracks on through the case. I struggle a bit with the 30-degree laparoscope knocking into his left hand but we make it through!
With a slightly sore back and hungry tummy I wolf down my sandwich (ham and cheese again… snore!) and head to the ward. CT is back for the patient; no leak!
Hurrah! Small amount of free fluid but in keeping with post-op. The patient himself looks better and had actually opened his bowels in the mid-morning – music to a general surgeon’s ears!
The afternoon clinic reg list has twelve patients on it with fifteen-minute appointments.
As I arrive the friendly clinic nurse asks how my morning was and how I liked my coffee! Clinic is so much better than running around A&E…
How on earth you’re supposed to take a history, examine, explain a diagnosis, book a patient for theatre and dictate a letter all in fifteen minutes is beyond me.
But I try my best! Trickiest patient was a young man concerned about the use of mesh for his inguinal hernia repair. He’d read a BBC article on chronic pain and a panorama documentary on mesh eroding in vaginal tape operations.
This was a tricky one. I first off congratulated the patient on being conscientious and keeping himself well informed. I explained what mesh is, how it works and why we use it.
I then outlined the risks, including chronic pain that he correctly mentioned. I printed off an information leaflet from the British hernia society that helps reassure him. He wasn’t happy that we use non-dissolvable meshes though, and asked me if we could repair it without mesh.
I explained that I’d check with my seniors if anyone offers that where I work (they don’t, it turns out!) and I would write to him. Non-mesh inguinal hernia repairs aren’t part of our curriculum, and I wonder if I’ll ever get to see one myself to learn how.
To end the consultation I explained that ultimately it is up to him if he wants us to fix his hernia and I was happy to book him for this, and he could cancel at anytime if he changed his mind.
He was happy with this, and thanked me for my time. I looked at the clock – an hour had passed. I felt sorry for the three patients left and apologized profusely to each one.
I finish the clinic at 6.30pm, and head back across the car park.
Leaving late doesn’t matter so much when you enjoy what you do, so I’m very lucky! Same time tomorrow…