Live stream! Well, I plan to add to this post during the day unless things really go pear shaped and it gets busy. Am on till 10pm.
0815 – am onto my third coffee. Is this a good idea? Am meant to be in the neurosurgery theatre today, but they have no cases for me so far, which is good news for everyone who hasn’t been diagnosed with a brain tumour for Xmas.
0930 all ready to do a general surgery acute from ICU when we get the call from the emergency department – a category one (super urgent) brain bleed with blown pupil in an elderly gentleman – 15 minutes to get theatre completely changed over for the craniotomy. Then we get the word – the case is off. After long discussions, the family have opted for palliation. Sad but realistic. That will cast a pall over their Xmas. So, it’s back to plan A. 15 minutes to change theatre back and go to ICU to get the patient, only to find the general surgeons and ICU have made a plan between them to do the case in ICU as it’s just a dressing change. Lots of work to achieve nothing so far!
1200 Finally managed to do a case, another general surgery acute, debridement of a sacral pressure sore in a young man, paraplegic after a car accident earlier this year. This is a population that would really benefit from automated driving. Technically very skilled behind the wheel of a car, I’m sure, but with insufficient aversion to risk taking. The surgical registrar seemed a little at sea, not surprising as up to two weeks ago he was a very experienced urology registrar. Such are the vagaries of the surgical training scheme. “What position do you want the patient to be in, lateral or prone?” “Ummmm….well, I haven’t actually seen the wound” “do you think you’d like to go and check?” “That’s a good idea!” Luckily his boss came in for the actual surgery. We do love adequate supervision. The old days of sink or swim, “just box on!” or even “feel free to cope” are mostly gone, thank goodness.
Slim pickings at the hospital cafe. All the corned beef sandwiches you could possibly want, but otherwise not much there.
1:30 well, this is embarrassing. Have had nothing official to do since lunchtime. This is very unusual, I just want to put that out there. It will soon get to the point where I’ll have to wrest the duty anaesthetist phone off the daytime person and start sending people home early. Currently sorting through my neglected and burgeoning hospital email inbox.
2pm mid afternoon snack time.
Not a gift from a grateful patient, surgeon or colleague, I hasten to add. It’s from someone I buy Xmas hampers from every year. It comes with one of those newsletters where you find out everything her overachieving children have been up to this year, which I have finally learned not to read. Into the bin it goes. I’m not even going to look at the photos.
1500hrs Super last minute shopping in the hospital gift shop; they were closing the doors while I was in there. My daughter lost her favourite fluffy toy a few years ago in a tragic boating accident, but she has asked me to stop trying to replace it. Frustrating. Hospital gift shops are like an Aladdin’s den (cave?), they have all sorts of stuff in there. Toys and knick knacks of all sorts, get well cards, magazines, snacks and lollies, and then all sorts of necessities for a brief unexpected stay – toothpaste, soap, deodorant, urine bottles (wasn’t expecting that one I admit. You’d hope the hospital might supply those if needed??)
1540 hrs
Twas the night before Xmas, and all through the theatres, not a creature was stirring, not even an orthopaedic registrar… yes, things have really emptied out on the theatre floor, and it’s very nice to be able send staff home a little early. I’m not going to say it’s quiet though (apart from the obvious, ie it’s forbidden), as there are plenty of obstetricians about. We are in the midst of a preXmas rush of vaginal bypass surgeries happening today – no one wants a Xmas day baby it seems (even though it was good enough for Our Lord).
16:30 hrs Send one of the regs to ED for a trauma call. She has just put a central line into a patient and has delegated to me the task of ordering a check chest X-ray. Turns out the whole process of ordering them via the hospital intranet has changed since I last did it. I finally order it but the radiographer says the order never arrived. The reg returns – trauma call a false alarm thank goodness, the patient arrived awake and talking – turns out she doesn’t know how to order xrays either (clever delegating on her part). The kind radiographer comes up to take the X-ray anyway and shows us how to do the ordering. Turns out I’d booked an X-ray as an outpatient in a few weeks time.
1715 hrs
An ectopic next, stable luckily. I wonder if the gynaecologist will try to reimplant the embryo into the uterus as they are trying to make a legal requirement in one of the more bonkers states in the US at the moment? If they tried I would have to manually restrain them, to be honest, and call in a more senior surgeon, because it’s in the realms of science fiction and not an actual physically possible procedure. What a time to be alive.
17:30 hrs.
Central line patient making the occasional dog like yipping noise, scaring the bejeesus out of passing staff members but providing tremendous amusement to the PACU staff. He’d been very anxious before his procedure and so had had a tiny bit of iv sedation. Time for him to go back to the ward in my opinion.
18:30 hrs.
Still going with the ectopic. Appendix to follow. Have just had dinner. Vegetarian lasagna was fine, the problem was all the festive food that everyone has brought in (who were more organized than me). Am full of chocolate, cake, and doughnuts. Hope to have room later for a mince pie. Lovely wide ranging conversations in the tea room on various topics, including politics. English reg gives her take on the recent UK election – the Conservatives lie well, Labour tells the truth badly. She can’t believe we have another general election here next year. It does seem too soon. Four year terms more sensible.
19:20 hrs
Ectopic finished, about to start the appendix. Young fit, healthy patient (apart from appendicitis, presumably) and I have two experienced registrars at my disposal. They’ve both had dinner so there’s not much for me to do, to be honest. Have just done a New York Times online quiz on how many photos of famous Americans I can name. I did pretty well, better than 53% of actual Americans (who do Times quizzes).
19:40 hrs
I couldn’t wait! Like Oscar Wilde, I can resist anything except temptation. I ate a mince pie even though I was still full from dinner. Now I feel sick. Is this a sign of things to come over the festive period? I’m very much afraid it is.
20:45 hrs
I can’t remember the last time I had an evening like this. It’s very atypical. We usually have two theatres going all evening. It’s very nice that people aren’t sick and needing operations, but it does make the evening drag rather.
21:30 hrs
Two experienced regs, no cases in theatre, no cases pending tonight, PACU empty: time to go home. Thanks on call person!
Merry Christmas all.