I just finished a stressful night shift in the surgical ward. It's my 6th night in a row and the previous nights have not been easy either. There are a few sick patients who demanded a lot of time and resources from medical and nursing staff. At the beginning of my shift last evening, I also just found out that one of the patients i saw the night before was taken back to the operating theatre for emergency surgery yesterday morning and was found to have ~2L of blood in the abdomen. She didn't look that unwell when i saw her, just some abdominal pain which was present even before i came on. Her belly was soft, stoma was working, bowel sound present, good urine output and all her vital signs were within normal limits. The only thing abnormal was she had a markedly elevated APTT (test for blood clotting) whilst on heparin infusion (blood thinner) which we responded appropriately by withholding the heparin for 2 hours and re-commenced at a slower rate according to guidelines. The only I did not check at 2am was her haemoglobin. Bad mistake. In my mind, intra-abdominal bleed was not even considered because she must be my 8th or 9th patient this week who had markedly elevated APTT. All of them were fine and the APTT normalised the day after. Well, all but this lady.
During the morning handover, I saw how the night registrar was being fired by all the seniors for the patients that he admitted. 'Have you discussed this with Dr H?', 'What did the urine dipstix show?', 'What was the reason for MRI cervical spine?', 'Can you get a normal lactate with ischaemic bowel?' Questions after questions. I imagine that must be extremely stressful and even humiliating at times when you could not answer your superiors' questions. It just re-emphasises that point that surgery is such a fine art of which the treatment, be it surgical or conservative, needs to tailored specifically, timely and appropriately according to patients' presenting complaints, clinical signs and investigation results. There is an old saying which goes: a good surgeon knows when to operate, a great surgeon knows when not to operate. Whenever bowels or organ viability and haemodynamic stability are in question, there is no time for delay. Definitive action is required and that's when most junior registrars run into trouble. Knowing when is a good time to ring your boss (mind you, i am talking about waking your boss up in the middle of the night to discuss patients and risk his/her wrath), having a coherent story and all the investigative results at hand, organising and liaising with members of other department to book a patient for surgery, and finally mustering the courage to call are certainly a challenge for every junior registrars doing night shifts. I am having anxiety and goosebumps even thinking about it.
Last Thursday I just had my interview for the Surgical Education Training (SET) programme. It's the final hurdle to enter into the ever-competitive, much-coveted surgical training programme. The entry into the surgical programme is based on three things: curriculum vitae (which is based on work experience, research experience, achievement, awards and teaching), referee reports (you need five referees who can back you up) and the surgical interview. There is probably around 500-600 people in Australia fighting for 50 slots. So only about 1 in 10 would get into the programme. The interview consists of 5 stations, each station manned by 2 experienced surgeons, 10 minutes per station.
The interview was very stressful. The time is so limited and the surgeons all kept a straight face. Throughout the interview, they either remain silent or they ask: anything else? anything else? anything else? It just gives you a deep sense of inadequacy that you are missing something.
I think i did average. I was feeling reasonably confident and happy in some stations and doubtful in others. This year where only 1 in 10 would get a spot, average ain't going to be enough. You have to be extraordinary in your performance to stand a chance.
One thing i am happy with myself though, that is i did not ask for the interview questions from those who had finished the interview. I felt God had spoken to me, to put my trust in Him and to do it His way. One day before my interview, I saw my registrar in the hospital and he was telling me i would be silly not to know the questions beforehand. The interviewers would be more strict because they expect us to already know the questions and have come prepared. But I have made my mind to do it God's way. If i want His blessing and favour in my application to the programme, I must put my trust in Him, knowing that He would open door for me which no one can shut and close door which on one can open.
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| Dead gut |
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| Missing our days in Delaneys Creek |
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| Running at the backyard of our house |
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| Running - compared with surgery - is a so much more relaxing and free |
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| Love the smile on Rachel's face :D |
