A Day in the life of a CT1 Anaesthetics

By Zahra Essackjee

I arrive about 07:45, and after searching the shelves, change in to blues. On the theatre wall are all of today’s lists, so I pick up my list and head to the surgical admission ward. I start seeing patients, zipping in between the admission nurses, surgeons, specialist nurses and pharmacist.

I take an anaesthetic history; ascertaining if there were any issues with previous anaesthetics, serious co-morbidities and letting them know what to expect in terms of the anaesthetic. A quick “open wide”, getting the patient to nod and jaw thrust gives me an idea of their airway. Lastly, I try to answer any questions, “How long will it take?” Will I wake up during the operation?” and the surprisingly common “Could we film me going to sleep?”.

I bump into my consultant as I’m writing up the charts. “Straightforward patients on the list. Are you happy to just get on with it? I’ll stand in the corner of the anaesthetic room.” I’m about three months into my training. I know my basic doses for simple induction and emergency drugs, but there is a whole world of things that I don’t even know that I don’t know. Still, I nod as “getting on with it” with consultant help nearby is the best way to learn.

After team brief, I check my anaesthetic machine; making sure I can give my patient oxygen, use the suction and ventilate. I chat to my ODP discussing size of laryngeal mask, endotracheal tube, antibiotics indicated as well as drugs needed. I draw up my drugs in readiness.

First patient is fit young man. Of course, I fail to cannulate his rope-like veins that are visible from space despite my time in the Emergency Department competently cannulating all manner of frail, dehydrated ladies and IV drug users whilst sleep deprived. Thankfully the second cannula goes in smoothly. Now we make idle chat to put the patient at ease; “Have you come far today?” “What would you be otherwise doing today?”.

The induction starts with a dose of fentanyl then propofol. A whole syringe of the white drug goes by and he’s still awake. My consultant nods as I reach for another syringe and I’m beginning to wonder if he will ever drift off. Finally, his arm slides off his lap, caught by the theatre assistant. Time for the muscle relaxant. Once it’s in, I hold the mask to his face and lift his chin. I turn on the volatile and squeeze the bag, pushing gas into the apnoeic patient. It’s now a waiting game. I press the alarm pause on the anaesthetic machine, it’s exactly two minutes.

I smell the volatile despite my best attempt at a good seal, there is a reason why they say beware of men with beards. Luckily my friendly neighbourhood ODP is handing me an oropharyngeal airway before I begin yawning. Two minutes are up.

I place the laryngoscope into the patient’s mouth, and try to consciously remember to lift up towards the ceiling and not lever on his teeth. “Grade 1 view.” The endotracheal tube is put into my hand, and so I direct it towards the glottis. I see the tube pass the cords, but the proof is in the pudding. I connect the tube to the circuit, and hold my breath as I squeeze the bag. Chest rising, tube misting and C02 trace. Success. Tube tied in, 22cm at the teeth. First hurdle overcome.

We are ready to head in to theatre.

The patient is brought through into the operating room. I make sure that I have a constant grip on the tube during patient transfer, my nightmare is trying to deal with a misplaced tube. I reattach the tubing, turn on the oxygen and volatile. A test squeeze of the bag, reassures me that the tube is still working and so I switch to the ventilator. I recheck my monitors and settings once the time out checklist is completed.

“Are we ok to start?” asks the surgeon. Glance at the monitor, C02 trace good, blood pressure check, heart rate acceptable, oxygen sats good, MAC high enough. “Please go ahead.”

I watch carefully as the surgeon puts knife to skin. This is the test of my anaesthetic. Is my patient deep enough? My eyes swing to my monitor, looking for any sign of haemodynamic change. There are none. Second challenge met.

The anaesthesia flight has taken off and the analogy holds true. The main part of the operation is cruising from the anaesthetic point of view. Aside from the minor adjustment of volatile, gas flows and administering some IV analgesia, anti-emetic and fluids as required I can relax and complete my chart. My consultant relieves me for a break so I can grab a coffee (the lifeblood of all anaesthetists) but for remainder of the time is happy enough to leave me to it; making sure that both I and the ODP know where they are should we need any assistance.

“How much local can I use?” I’m not quite quick enough to figure this out in my head yet, but after some straight forward maths scribbled on my list I can tell the surgeon a safe dose for local anaesthetic infiltration of the surgical site. This is a signal that things are coming to a close. Time to check whether the muscle relaxant is safe to reverse. Four strong twitches. Good to go, I give the reversal agent.

I look over and they are closing the skin. I turn off the volatile, but keep my flows low. This is the bit I still find tricky, timing emergence. The final challenge. Thankfully he is starting breathe, so I turn off the ventilator.

Once the theatre assistants are starting to pull off the drapes, I take that as my cue to turn up the oxygen to encourage my patient to blow off the volatile. The patient is transferred onto a trolley, and I sit him up, watching his chest movement. All other monitoring comes off, leaving just the pulse oximeter. The rest of the theatre is tidying up, but amidst that chaos I’m watching for signs that my patient can now take over his own breathing fully again.

And it comes. First it’s a silent cough. Then a bucking. I untie the tube and suction his airway. Finally, the sign I’ve been waiting for: he reaches for his tube. “It’s ok, you are just waking up. Stick your tongue out so we can take out the tube.” The ODP deflates the cuff and I pull out the tube. I hold the Hudson mask to my ear to check the oxygen flow and then place it on his face. For the next minute I closely watch his breathing and sats. It’s regular and the sats are normal. Great, time to go to recovery.

After handing over to the recovery nurse, I congratulate myself on a successful and safe anaesthetic. In the early days, it is definitely a victory. Well, now it’s time to psych myself up for the next patient.

A Day in the life of an F1

By Zana Martin

As a newly qualified FY1, typically each day has something new to offer. I’m currently based in care of the elderly, spending my time with a fantastic team of people and facing new challenges daily…

Each day starts with a full board round of every patient, where we discuss recent results and more importantly discuss discharge plans. As the FY1 my role usually entails shouting out the significant blood results and chipping in with and titbits of information I have managed to glean from family members. From there, we divide and conquer, each taking a handful of patients, for which we are responsible that day (being on a well-staffed ward makes all the difference!). 

As the clinician responsible for those patients, it is our job to ensure jobs are done and discharged letters prepared in advance, with TTO’s written early to avoid delays. Often this means you have 4 or 5 letters to prep in a day, which seems a lot but makes your life easier in the future! We are also responsible for updating families and the nearest and dearest, and asking the difficult questions when there is no clear plan surrounding resuscitation. While it was daunting initially, being able to have these conversations early on does allow for a good rapport to be formed between patients and staff and makes the journey a lot more pleasant for everyone involved. Believe me, the difference it makes when you remember a relatives name is amazing. 

One of the biggest challenges I’m sure every FY1 faces is learning to trust your clinical judgement and having the courage to implement a plan for a patient. Things like prescribing laxatives will induce panic, as will the thought of being around a patient with a EWS of anything more than one. Despite feeling like you will never be able to do it, the confidence and competence will grow exponentially in those first few weeks and suddenly you will find yourself wondering why you worried in the first place. For example being called to an unwell patient on the ward with an increasing oxygen demand and tachycardia (that was just me, not the patient) and feeling like a fish out of water, I managed to call on the 5 years of training and issue some basic management until senior help arrived. Thankfully the patient survived. That is certainly a personal highlight. 

But the most enjoyable part of FY1 so far? (And no it’s not the wage, though that is glorious) Is being part of a team and being able to make a difference to real lives, even if it’s something as minor as holding a patient’s hand while you speak to them, or helping to make a bed when there’s a lull in the day. Those small interventions that we don’t consider to be of value are often the most valuable to patients and their families, and are what make the job special. 

Life as a locum doctor

There’s a lot of pressure on young doctors to go straight into specialty training and tick certain boxes for fear of damaging their career chances.

I never planned on having a conventional career in medicine. I always wanted to do relief work and work in the international healthcare setting.

Earlier this year I travelled to Iraq to be part of a medical mission with a small NGO called Global Kindness Foundation. 

They set up dental clinics and optometrists in schools in Najaf and Karbala. These schools are mainly attended by orphans and disadvantaged children.  We set up a rudimentary clinic and as the only female doctor on the trip I provided primary care and health check ups to girls from between the ages of 6-18 years of age. 

 I’ve also visited Northern Greece with another NGO called Health Point Foundation as their co-ordinator on ground for 3 months. We were the main providers of dental care to over 15 camps within that region. Everyday we’d pack our clinic equipment into a car and set up in a new camp. I was involved with inducting, supervising and assisting the dental volunteers. I was also the main liaison for regional government and other NGOs in the health sector and worked hard to expand our efforts to the refugees in other camps or squats. 

After that I went onto study for a diploma in tropical medicine and hygiene. I’ve since been out to Lebanon to assist in the set up of medical clinics for refugees close to the Syrian border. 

Why did I get involved in these projects? It’s what I’ve always wanted to do. 

I worked as a locum doctor in between trips, which meant I had the choice of working or the freedom to leave the country for months at a time – something I couldn’t have done in specialty training. I was also fortunate enough to visit Sri Lanka, Turkey, Switzerland and Germany in this time. 

I know the experiences I have had are beyond value and have given me skills that will be an asset in the future.

To sign up with Holt Doctors and receive your bonus go to the locum page on our website https://www.whatthebleep.co.uk/holtdoctorsbonus

The Home Visit

By Catriona McNicol, June 2018

There are certain situations that can test even the most experienced of GPs in a home visit; the clammy cardiopath clutching his chest as you enter the flat, the elderly lady with lips so blue from hypoxia that you genuinely try to wipe her funky lipstick off before you realise her sats are 76%, the young distressed psychotic patient who is a real risk to himself and his ever faithful mother or the angry, aggressive relative who just needs to vent at a doctor and you happen to be the one doing the home visit.

It’s just you, your bag, your clinical skills, your best chat and a big dose of, “you’ve got this”.

But nothing prepares you for that single terrifying moment which you know is going to happen at some point. That point of no return. That awful experience which ultimately makes you fear every other home visit you’ll ever do. 

That time when a parrot lands on your head. 

No words. None. I am a broken woman.

The Truman Show

By Catriona McNicol 

Please, please tell me that I’m not the only person that this kind of stuff happens to, because I’m beginning to think that I’m on some sort of Truman Show. 

The day started well. Unbeknown to me, it turns out that the very pleasant, but possibly mildly stoned youth who takes your orders at the drive-thru McDonald’s has come to recognise me.

“Hey, good to see you. You’re early today, one white coffee, the usual price!” he offered as he held out the contactless card machine. 

Wow, I spend a lot of time and money in here. Mental note to self, “Stop this”.

I threw back some friendly comment and he said, “You’re always so happy, that’s a nice thing”. I was quite taken aback, but flattered nonetheless. 

“What’s not to be happy about? I’m getting a take-away coffee! It’s my favourite part of the day”, I said, a little too jolly for pre-caffeine interactions. 

His eyes narrowed and he offered a half smile, “you’re favourite part of the day is getting a drive-thru McDonald’s large white coffee? That’s not a good place to be in, dude. You gotta start living a little! On to the next window! See you tomorrow”, he said as he closed the glass divide before my eyes. 

Oh. My. God. The marijuana-smoking, slack lining dude who works in McDonald’s just gave me lifestyle advice. 

I chugged on in my little red car playing an old cassette that I recently found in my neighbour’s bin (this is a true story…she’s a neonatal consultant and well aware that I’ve pilfered it). Turns out it was the Beautiful South, Carry On Up The Charts, and with the sun shining down it felt like a good choice. 

I rocked up at work and reversed my car in to the ‘doctor’ space outside my surgery, painfully aware of the worried looks of the patients who eyeballed my 18 year old car that sounds like a foghorn in light of the detached exhaust. I stepped from the car and dropped my doctor’s bag, the contents spilling everywhere. Why hadn’t I zipped it up? I looked like an incompetent numbnut, but I gathered it all up, scooped up my coffee and headed into battle for the morning. 

The morning surgery went well. I felt in control, I did some good doctoring and I left enough time to scrape together the relevant paperwork to dash over to the other side of the city to meet with my Educational Supervisor for the much needed ES Report. 

Right, got to go. I have 18 minutes to travel the 17 minutes it takes to get there. Just need my keys. My keys. Just need them. 

I looked EVERYWHERE. I almost recalled my patients to look in their shoes, pants etc on the off chance that they’d been waylaid during examination. I looked upstairs, in the toilet, in the staffroom, on the stairs. 

Eventually after 15 minutes of sweating I figured I should check outside around my car so I headed into the blazing sunshine to look around my vehicle. Nope. Nowhere. 

What the flock was I going to do? I leant against the car wondering how I could transport myself to the other side of the city and low and behold, the wee buggers were sitting on the driver’s seat with the front door open about an inch. 

Now, thankfully the good folk of the affluent North Leeds suburb in which I work must have recognised that any form of jail time for this old beat up car wasn’t worth it, and the vehicle and its contents were untouched. 

I hopped in and wound down the window, pressed play on the cassette player and drove the 200 metres to Sainsbury’s. It was short but satisfying journey. I knew I was going to be late for my ES meeting but I had to eat. I just had to. 

I parked up outside a pedestrian entrance to the precinct, keeping an eagle eye for any dead equine (see earlier post), wound up the window and then ran into the shop. I did a supermarket sweep (RIP Dale) and was out in no time at all. 

I ran towards the small path where my car was parked just beyond and as I approached the zebra crossing, just on the corner, my life flashed before my eyes. Round the corner, at speeds way beyond those that should be acceptable for pavement based vehicles, came an elderly lady with a glint in her eye and the wildest hair I’ve ever seen. 

We briefly made eye contact before she, yes true story, ran me over. I repeat, today I was run over by an old lady on a mobility scooter. As in hit by the scooter, knocked to the ground, and she ran over the end of my shoe, narrowly missing my toes. 

What the actual Chuffing Nora? 

I was slightly dazed for a second before I stood back up, and yes I could feel everything and nothing hurt too much. I was about to open up a can of Whoop Ass when she looked at me and said in a proper wonderful West Yorkshire accent, “oooo luv, are you ok? Ooooo, I’m so sorry. I think I was going too fast, I’m on my way to get some cat food for Neville, he’s got poorly kidneys and needs one of them reduced protein meat sachets”. 

And this is my life. 

Run over by a mobility scooter because Neville The Cat has got freaking CKD. 

I brushed myself off, calmed the lady down and made sure she was ok before strolling back to the car thinking, “I’m totes telling the McDonald’s dude about this tomorrow. I’ll show him living life!”.

All change again

By F1doc

I can't quite believe it, but apparently it is time to switch rotations again. On Wednesday I will have completed 2/3 of FY1 which means that in just 4 months I will be an FY2. Fresh faced graduates will be shadowing me for a week and expecting me to have all the answers. All seems so strange.

I have to be honest about my second rotation, I was dreading surgery and for the first few weeks that dread was a reality. I didn't like my job much and I got anxious about the day ahead. Mainly because it was such a shift from medicine which I had come to know and love. 

4 months on and I am actually sad to leave surgery. Now don't get me wrong- I ain't no surgeon. I actually laughed out loud a few weeks ago when a patient invited me to sit on her bed and chat with her. " You don't want to do surgery, do you dear?" 

"No, I said" 

She smiled at me and replied " I thought as much".

But despite not wanting to be a surgeon there are many things I will miss about being a surgical FY1:

Ward rounds are quick which means you have time to do your jobs during the day and I mainly leave work on time.

I worked in an office with other FY1's which meant I got to make good friends and it was very social.

A lot of patients were young and relatively well, after their surgery they got better quickly and went home. 

It taught me to be less squeamish- after having bile thrown up onto my shoes, a stoma explode in my hands and seeing more pus filled abscesses than I though possible I can honestly say that there isn't a bodily fluid that will stop me eating my lunch any more. 

So it is with some sadness that I leave the past 4 months behind me, but only some, because my final FY1 rotation is psychiatry. The dream!

The Hadiza Bawa-Garba case is a watershed for patient safety

By Rachel Clarke for BMJ Blogs. 29th January 2018

Watershed moments, if genuine, are palpable. We can feel it when something tectonic is afoot. Who will forget how, last year, the blackened shell of Grenfell Tower fractured a country’s belief in itself as fundamentally humane? Or the fury unleashed by Harvey Weinstein’s victims, and the potency of #MeToo as it rips round the globe?

Medics have a habit of thinking nothing matters quite so much as medicine. But last week’s successful appeal by the General Medical Council to have paediatric trainee, Hadiza Bawa-Garba, permanently struck off the medical register is nothing if not an NHS watershed.

What is at stake here—as unsafe staffing continues to wreak havoc on our ability to provide patient care—is whether the profession’s regulator finally has the gumption to confront this reality. Or, will it continue to ignore the state of the health service, thus permitting individual practitioners whose abilities—it knows full well—are so crippled, so often, by skeleton staffing, to shoulder the blame for NHS-wide failings? If ever there was a moment to put patients first, this is it—as people continue to die on trolleys in hospital corridors, or at home while waiting for the ambulance that never arrives.

In 2015, Bawa-Garba was convicted of gross negligence manslaughter for the avoidable death, from sepsis, of a six year old boy, Jack Adcock, after a jury concluded her mismanagement of the child was “truly exceptionally bad.” The GMC then insisted that public confidence in the profession could not be maintained unless Bawa-Garba was permanently erased from the register.

Superficially, this may seem reasonable enough. A young child had died in unforgivable circumstances, a doctor criminally convicted. So why has her treatment so convulsed the profession? We are angered, in part, by the absence from the GMC’s narrative of the possibility that Bawa-Garba’s negligence arose because it was the working conditions into which she was thrust that day that were “truly exceptionally bad.” Rota gaps forced her to cover two other doctors’ jobs as well as her own work. Her consultant was off on a teaching day. The hospital IT had broken down, causing chaos.

So what, precisely, was Bawa-Garba meant to do? Down tools and say it was unsafe for her to work? Is that what we should all do now—simply walk out on our patients when rota gaps are dangerous? Or struggle on, sick with dread, knowing a patient may slip through the understaffed net, and that we too may face criminal conviction as a consequence?

When this question was put to him last week on BBC Radio 4, the GMC’s chief executive, Charlie Massey was evasive, refusing to answer. Small wonder doctors are afraid. Many of us battle daily with understaffed bedlam. Fancy a spot of corridor medicine, anyone? Picking the patient you think will die next in the corridor, to award them the one empty space in Resus? Yet the GMC’s only advice to those trainees now terrified of both treating and not treating their patients is platitudinous—essentially, to tell someone senior you think conditions are suboptimal.

That, frankly, is not helpful. What is the point of frontline doctors speaking out about understaffing when all those with actual clout—the GMC, the CQC, Jeremy Hunt, and the prime minister—know that in today’s overstretched NHS, patients are jeopardised by rota gaps daily. It is ironic that the profession’s regulator, so committed—ostensibly—to NHS candour, is itself refusing to be candid in public about the dangers to patients of endemic understaffing.

Last week, doctors took matters into their own hands, crowdfunding £160,000 in donations in less than 24 hours to provide expert legal opinion for Bawa-Garba. Those are sobering statistics for a regulatory body that purports to uphold public confidence in doctors—yet appears to have lost the trust of its rank and file.

Vague and hollow reassurance from the regulator no longer cuts it for doctors. We need action, not empty words. In the spirit of preserving patient safety, the GMC could set a powerful precedent by speaking bluntly about the dangers of rota gaps. It could insist we report every single one of them, and make it quick, easy, and—crucially—safe for us to do so. A simple, anonymised GMC form on which we can document every staff shortage without fear of employer retribution. It could collate these data nationally and publish them openly. Imagine the force of a GMC divulgence of the scale and repercussions of doctor understaffing.

Recently, I had a conversation with a senior figure in the NHS who, irked by doctors speaking out, asked me: “Don’t you think you have a corporate responsibility to maintain public confidence in the NHS?” I took a deep breath. The rot that passes for “candour” could not have been phrased more succinctly. “No,” I replied. “I think quite the opposite. Covering up risks, if they exist, is the exact opposite of candour. If I thought it was okay to spin away reality, I’d be a politician, not a doctor.”

It is time for the GMC to choose. Does it wants to be part of the problem or the solution? Because, right now, every one of us could state the same refrain: #IAmHadiza.

Rachel Clarke is a specialty doctor in palliative medicine. Follow her on Twitter @doctor_oxford

WhatsApp with the Bleeps?

by Dr Rhydian Harris,  25th January 2017

You’re about to insert a chest drain when your bleep fires. Hands tied up, you just about manage to see and memorise the number before a second bleep sounds and a request for yet another call appears.

Gloves off, you start the process of trying to answers the bleeps. Phone at the nurses station is out - pharmacist waiting on a call back from the F1 – so into the office you go.

First number - 3999; line engaged. Onto the second, 4752. “Anyone bleep intensive care?”  you hear yelled down the ward. “Sorry doctor, he’s with the patient, can you call back in 5 minutes?”

Off goes your bleep again – 3999 on the screen – turns out the line was engaged when you called back because they were bleeping you again.

Bleeping is just as frustrating for the caller. Sat by a landline, waiting for a call back, not knowing who is at the other end, or whether the bleep has been heard, unable to carry on with other tasks. It’s a maddeningly out-dated system.

Though reliable at transmitting the need for a discussion, bleeps lack any context, indication of priority, and fail to identify the caller. There is no feedback on whether the message has got through - the bleep could be switched off or have a dead battery, or the holder may not be able to reply due to being scrubbed or otherwise too busy. Sadly, this results in patients suffering adverse outcomes due to delays in contacting clinicians for review. 

Little wonder, then, that clinicians have started using their phones to co-ordinate patient care.^[1] The rapid dissemination of information, knowing who you will find at the other end, and the ability to know when your message has got through are key draws that bleeps do not offer.

The impact these workarounds can have on patient care are remarkable. WhattsApp groups have been used to control response to major incidents in London.^[2]Paramedics in Argentina send WhatsApp photos of ECGs to cardiologists for review to ensure the right patients get to primary coronary intervention (PCI) in a timely fashion. Similarly, we’ve heard anecdotal stories of UK clinicians sharing ECGs with their local PCI centre via WhatsApp because of fax machines being slow and unreliable.^[3] Further examples include sharing photos of x-rays, blood gas reports and CT videos with off site consultants; a picture is worth a thousand words, particularly when it’s your half asleep boss at 4am!

WhatsApp is not without major drawbacks, which place the clinician in a difficult position. It’s well-known end-to-end encryption does not prevent data being sent outside the UK. Data is also permanently kept on the handset and is not pin protected, leaving it open to being seen by the wrong eyes.^[4] As many will have experienced, it’s all too easy to send a message to the wrong person. Hospitals are tightening up their policies with new General Data Protection Rules coming in May 2018. Breaches of data governance are a huge problem legally, and doctors face disciplinary action if they are responsible.^[5]

The work around many use day to day is to anonymize patient data. This is cumbersome and leaves room for error – defeating the purpose of using the messaging platform. A further difficulty is that the clinician is limited to contacting those whose personal numbers they have, resulting in a default to bleeping.

The need for a solution is why we, as junior doctors, have built Forward. Forward is a secure messaging platform, built to feel like WhatsApp, but also allowing patient profiles and images to be shared.^[6] Forward provides a searchable “My Hospital” and UK wide directory of users,  QR code scanning to instantly populate a patient list, and simplified workflow with task lists shared and updated by your team in real time. We encourage clinicians to download Forward - to save them frustration, and free up the time to do the things that really matter. 

Forward Clinical Ltd is run by a team of NHS junior doctors. If you would like to discuss bringing Forward to your workplace, please email Rhydian@forwardapp.co.uk

Forward is free to download and use, and is available on the App and Play stores. It is NHS Information Governance Toolkit Level 2 certified. 

More info at http://forwardapp.co.uk/

---

^[1]http://innovations.bmj.com/content/early/2017/10/24/bmjinnov-2017-000239

^[2] https://traumagasdoc.wordpress.com/2017/07/23/whatsapp-doc/

^[3] http://blogs.bmj.com/technology/2017/11/16/whatsapp-in-the-nhs-framing-the-problem/

^[4] https://www.hsj.co.uk/technology-and-innovation/clinician-use-of-whatsapp-is-a-ticking-time-bomb/7020115.article? utm_source=t.co&utm_ medium=Social&utm_campaign=commentfeed

^[5] http://www.bmj.com/content/358/bmj.j4099

^[6]https://www.igt.hscic.gov.uk/AssessmentReportCriteria.aspx? tk=430647085572384&lnv=3& cb=3121afa9-23e7-4d6e-8b8c-dd90efef23f0& sViewOrgId=53443& sDesc=8JP98

Medicine V Surgery

By F1doc.

This time last year I was busily prepping for my med school finals and it seems like a lifetime ago. If there are any med students reading this, then please stick with it. Time will fly past and I can honestly say that I have LOVED the past 6 months as an FY1. It is a wonderful job.

Life as a surgical FY1 is drastically different from being a medical FY1.

Surgery is incredibly fast paced for short bursts of time and then it slows down. But you never know when that 'burst' is coming.

I'm learning that if a surgeon asks you for a scan, they mean they want the scan NOW! Ward rounds are faster than fast and I am much better at taking blood than I was on medicine.

The thing i'm enjoying most about surgery is that it is more social, there is an office where 7 of us surgical FY1's are based and although we aren't often there all together there is usually someone there you can chat with or ask for advice. 

Don't get me wrong though, i'm definitely NOT a surgeon. I miss medicine a lot. I miss having time to really delve into what is going on for a patient, to piece together all the pieces of the puzzle. The speed of the ward rounds mean that I often panic I've missed something and end up having to go back and check all the observations and previous note entries.

I still haven't actually scrubbed up and been in to theatre, which is something I need to make myself do before this rotation ends.

Outside of hospital life i'm finding it hard to exercise which is one thing about being an FY1 that really gets me down. It is probably more of a problem now because of the dark evenings, I don't like running in the dark and I cannot afford gym membership that I know I wont use. I'm really hoping that as the  daylight hours increase I will find the motivation to get my running shoes back on.

Being an FY1 is amazing, as I keep telling everyone but I do need to remember to look after myself too.