Ch-ch-ch-changes....

So it's changover week this week, the most horrifying week on the Foundation Doctor Calendar (aside from when they instated that bizarre and inexplicable Rectal Exams 4 All campaign). Given my general hatred of change and of things unknown my lungs are filled with fear or, possibly, pus but at least my larynx has returned to it's normal effeminate self which will no doubt help me sing those top Cs, if not pull any birds.

(BTW I hate the term 'birds', but I can't confer enough sarcasm on here)

In the news this week. Oh I don't remember, it's not really this week it's like 14 days in the FUTURE and I've been at work around 90% of the hours during that time so the only thing I can really remember is FUCK YOU WARD 313.

More of that later.

Day 1

08:00 Sri ward round. Perhaps the last opportunity I'm going to have to have him legally adopt me and, possibly, shun all his other children in favour of me.

"Geoff" he says after it finishes "I'm so glad you're happier this week"

He then does an irritatingly realistic impression of my general demeanour last week, largely by his use of the phrase "Fucking Brodie, Excellent?! Fucks sake what's the fucking point in this fucking job"

08:45 Mr Mortimore, having just delivered the diamonds to Captain Zero (though he did briefly consider given them to dem GOVment cos at least dem GOVment gonna pay him) is giving us a long list of instructions about two patients.

"OK so you DON'T need Mr Chambers to go to theatre tomorrow?"
"No he won't be going"
"OK so shall I cancel him?"
"He's not booked"
"Oh I booked him yesterday because you said he needed an EUA?"
"No that's Mr Chalmers... you DO know the difference between the two right?"
"Um... sure, why not?"
"Because I've just given you a completely different set of instructions for each of them"

AH SHIT. Crushed again. And just when he seemed to think I was pretty decent.

09:00 Kat is on-call again which, given the fact she was on call most of last week AND was working all weekend, seems unfair. Because I'm wonderful I decide to relieve her of the bleep burden for the morning. As the bleed leaves her hand and touches mine it goes off.

Then it goes off again.

And a third time.

Hindsight will later reveal that bleeps going off every 4 seconds, sometimes even at the same time on top of each other in a ridiculous MULTIBLEEP or Multiple Bleepgasm, is par for the F1 course, but for ENT this is simply INSANE.

09:30 The first woman Mrs I. Have. Mumps. attends the treatment room with bilateral swelling of the parotid MUMPS IT'S MUMPS MUMPS MUMPS MUMPS. MUMPSY MUMPSY *cough* gland.

"So have you ever had mumps?" I ask her
"Yup I've had mumps but only in one side at a time"
"You've had it several times?"
"Yes, I've also had measles and rubella"
"Right... you've had Measles Mumps and Rubella?"
"Yea"
"Not vaccinated with the Measles Mumps and Rubella jab then?"
"Oh I think I had that too"

Whatthefuck? Does this woman HAVE an immune system? Did Edward Jenner just turn over in his grave?

"So how do you know you had mumps, did they do a blood test?"
"No my mum was the school nurse so she just told me I had it"

Now correct me if I'm wrong here, but school nurses... any kind of nursing qualification? Doubtful. Dodgy paedophile in drag? More likely.

Anyway she looks pretty ill so I admit her and put her on fluids and ring the registar:

"Have you considered alpha-1-antitrypsin deficiency on a background of subacute bacterial duchennes muscular dystrophy?" she questions
"The what now?"
"It doesn't matter just test her serum for positively biorefringent flavinoid molecules"

I'm horrified not only by the fact that this is clever stuff and that it is a SURGEON asking me, but also because I'm a frikkin GENIUS and I've never heard of it. To that end I just do an FBC, U/E CHEM 7 and a C-spine because that's what Mark Greene on ER would do.

10:30 Next up is a chavvy looking person.

"So I woke up, like, and one of my twelve dor'ers was like. 'whats faking wrong with your chin?"
"Verily"
"and sos I goes up to the mirror to see what the fak is going on and I notice I've got free chins"

I could, at this point, make fun of her inability to say 'three', indeed it did make me feel better about Sam's springy brown hair and endless riches when he had to use binary to express any numbers without looking like a special person, but as I began to type the invented dialogue it became more and more like that fucking terrible 'Fork handles? No FOUR CANDLES' sketch that makes me want to tear my own Face/Off. To that end I will transcribe the dialogue verbatim.

"I see, and has it got any better or worse"
"Yea it's got be'ar today innit like"

Isn't reality dull.

What's most concerning is not the fact that this story sounds like a total load of shit but that she, in reality, really DOES have a mysterious 3rd chin that, on palpation, is all weird feeling and strange (medical terms here I know, but hard to describe in layman's FOOL language).

I try to get hold of the registrar but she's too busy absorbing huge amounts of medical knowledge into her enormous throbbing brain/cutting out some child's tonsils to answer the phone. Fortunately Sri is hanging around looking generally indian and smiley and so offers to have a look.

10:45 After a thorough 5 minute examination Sri decides it's 'inflammatory oedema' which is medical speak for 'FUCK YOU WARD 313' I mean 'I have no idea' but we arbitrarily put her on some co-amoxiclav because that's ALL SURGEONS KNOW HOW TO DO.

11:15 I'm bleeped by the ever Natalie Portman-esque Kacey to find out if I'm going to ever review this guy with a thing stuck in his ear who's been waiting for hours and hours and hours. In fact she mentioned him to Kat on ward round but she. just. didn't. give. a. shit. /she thought Kacey was on about another patient

Hmm... note to self. How the FUCK do you spell Kacey... Best just shorten it to KC in future

Anyway, this guy is the nicest person in the entire world. Nicer even than Matt Lea (even though that's impossible). Not only does he not moan about sitting around for hours but he also is extremely grateful when I eventually drag the cotton bud out of his ear canal. He apologises for wasting my time and wishes me a wonderful afternoon.

Bless. His. Socks.

13:00 There are still quite a lot of jobs to do and I'm allocated my least fun kind, i.e. the ol' ring a consultant and tell him to do something because I want him to. I'm given this job because the consultant we're after, Mr Hosen, is on Upper GI Surgery, my next placement. However he isn't my consultant and also I have no idea how to get in contact with him (because, let's face it, I'm too pussy to just pick up the phone and ask for his number).

After around 45 minutes of faffing, which included going to find the current Upper GI F1 and asking him what to do, I eventually ring the guy and get his answer machine.

"Hi it's Geoff, and by Geoff I mean er... Andie Brodie... yesss that's right. I'm just calling on behalf of Mr Archer the ENT surgeon. He was wondering if tomorrow, during your busy surgical schedule, you might just be able to pop out and help him endoscope someone. I don't really know why but I think the guy might have cancer. If you could call me back then that'd be great."

Of course the chance of a consultant picking up the phone and ringing me, a lowly worthless F1, is more or less 0 but I can't bear the idea of ringing him every 30 minutes until he picks up and at least this way I can pretend like I've done the job and am not as incompetent as the ileoceacal valve of a 79 year old (e.g. very).

16:00 I realise that one of Mr Archer's patients is going to theatre so needs his warfarin stopping but also needs to be anticoagulated due to a metallic heart valve so, in an attempt to look clever and thoughtful I go to speak to Mr Archer.

"Hi, just so you know I've started Mr Chambers on Enoxaparin at therapeutic dose and his INR should be normal by tomorrow because they can't give him warfarin as it's only available orally"
"OK, but how were they giving it before then?"
"Through his NG tube"
"...What's happened to his NG tube?"
"I.... er.... guess... it came out?"
"WHAT!? We need that in for his contrast and to feed him and for all kinds of shit. You need to go down to radiology now and sort it out"

16:05 Having been a doctor for 4 months or so now I'm not anywhere near as scared of going to radiology as I once was. This is due almost entirely to the fact that everyone in radiology has so far been amazingly nice. Things, as ever, though are about to change.

"Oh hi, I'm one of the ENT team I was wondering if I could chat to you" I ask as the consultant ushers me through the door of his office
"Right. Are you a doctor?"
"Yes, yes I am"
"Do you have a name?"
"Oh yes it's Geoff"
"Geoff what?"
"Burnhill?"
"OK Doctor Burnhill, I'm Doctor Scary. What do you need"
"I was wondering if we could get a radiologically guided NG tube on a patient of ours"
"Why?"
"Well he's not able to swallow after an operation"
"What operation?"
"He had a tumour removed"
"From where?"
"His hypopharynx"
"What kind of tumour"
"A Schwannoma"
"A SCHWANNOMA?"
"Yes"

This conversation goes on for some time as he asks me ridiculous questions that can't possible help him decide whether the guy needs an NG tube or not but are designed purely to make me sweat. Fortunately for me I was in his VERY SURGERY and so know all the answers.

"And why didn't Mr Archer put the tube in?"
"I... I don't know... he I"
"It's OK, it's not your fault but it's no easier for us than for him you know he should really do it"

I think at this point the horror on my face broke what was left of his cold dead heart and he finishes

"but if you insist I guess we can do it. Though not today, by any means"

17:00 Mr Archer is displeased with this turn of events but, given that he no longer has any power over my ePortfolio, there's nothing much he can do to harm me. Needless to say he flogs me with a switch from the back yard for hours whilst forcing me to write lines using a pen that etches them into my hand, but my likelihood of getting a job next year is left untouched.

Day 2

08:00 Kat and Brodie appear TOGETHER (ooh errrr) looking rough. Kat berates me for giving her my germs while Brodie sits in the corner rocking backwards and forwards trying to swat away imaginary flies.

13:00 Nothing has happened all morning, except for the descent of Brodie into some hellish fever dream or other, and it's time for teaching. As last week was such a success I have laden myself up with sweets a plenty. Today's teaching is from a West African consultant who also taught us at GEM

"This guy is hilarious,"  I whisper to Matt as he begins "he always tells us that you cannot call someone mad until you've been doing medicine for 10 years at least"

<african dictator accent> "Hello everyone, I have come to teach you about respiratory problems. Now the first thing you must remember to do is listen to da patieent, because you may think he is mad, but you cannot say he is mad until you've been doing medicine for 10 years at least" </african dictator accent>


I look to Matt in a victorious "Didn't I tell you he's say that!! OMFG!!" type way but he ignores me.
Pah.

15:00 What with it being so quiet and everyone being so ill I'm beginning to feel like this final afternoon of ENT is a bit of an anticlimax. I don't quite know what I'd expected... surprise disco thrown by the consultants? Tearful hug-fest as we all say goodbye? Massive Orgy? Actually scrap that last one, too much of a sausagefest.

Instead I find myself sitting on a desk just waiting for 5pm to come around with noone else in the office. This is largely in keeping with all previous end of era type events in my life, particularly both graduations so I should be used to it but somehow it still makes me sad.

15:15 I'm asked to see a patient who has an early warning score of something high and the nurses are worred. "Come on Matt, let's do one last Team Awesome review"
"No" comes his flat reply "I've got loads to do"

In tears I go to review the patient, who I find sitting comfortably in bed with no issues at all. Stupid Early Warning Crap.

15:30 Brodie looks as though he is about to die in front of me and, as his subsequent resuscitation would involve far too much work for myself, I send him home. He had been holding on desperately to give a bottle of wine and card to his consultant but alas his consultant isn't here (to this day, the wine and card still are) so he's kind of lost.

16:00 Brodie comes into the office.
"I thought I said go home?" I enquire
"Yea but Matt wouldn't let me, he said there's loads of stuff to do"

It is around this point that I realise that clearly Matt has gone insane. There is never anything to do on ENT, Brodie is dying and there's another 3 of us to cope with the workload. I wonder whether Matt is secretly planning an amazing farewell party and so doesn't want anyone to leave before the cake arrives.

"Just go anyway" I say, keen for extra cake "Matt has clearly gone insane"

16:30 "So Matt, what's your secret reason for wanting Brodie to stay"
"Nothing, there were just loads of jobs piling up and I needed him around"

At this moment I realise something both new and horrifying. Matt is stressed. This is probably something to do with my emotional breakdown last week making him do all the work or the fact that I make him do all the work anyway. Another factor might be the imminent birth of his niece coupled with strained relations between his mum and his fiancee. A third problem could be the unstable economic climate and dim forecasts of economic recovery coupled with global warming, dwindling oil reserves and the fact that, somehow, there are still people that don't believe in evolution.

(Sidenote: You don't have to BELIEVE in evolution. It's like believing in my sitting room rug, it's there staring you in the face. I can't PROVE my rug is there but it's pretty frikking obvious)

17:00 Feeling like a terrible friend who fails to give support when it's needed I try my best, after being kindly invited for tea at Matts, to cheer everyone up. Me, cheer people up... HAAHAHAHA

Whether I succeeded in this I'll never know, because as of tomorrow nothing will ever be the same again.

Day 3

07:30 I arrive at work super early to suss out what, the fuck, goes on in the Upper GI surgery ward. Where are the notes trolleys? Who are the nurses? When is second breakfast?

The answer to the last question comes immediately. "Geoff, I don't think they've heard of second breakfast".

07:35 Just as I'm trying to scroll through the list to get my bearings and failing because the FUCKING SCROLL WHEEL DOESN'T WORK, Freddie Mercury enters the room.

Fearing that I've spent too much time trying to learn how to play One Vision at the weekend I rub my eyes hard and refocus to find that it is not Freddie Mercury but a very similar looking registrar. The half mic stand in his hand turns out to be an umbrella and the overbite is all but missing, though his ability to sing a top C, I'm told, is just as strong.

He immediately whisks my out of the office and starts a ward round. Without giving me time to blink let alone grab any notes he strides into a bay and starts talking to one the patients.

"OK, Mrs Smtih that's great we'll see you tomorrow" He finishes, almost instantly before turning to me "So, Ben is it?"
"Geoff"
"OK Ben this lady needs a TWOC, a C&S, AXR, FBC, UE, Plasmaphoresis and Coag. Then you need to speak to Jon Smith upstairs and organise an outpatient appointment for 3 weeks, making sure to order her IgE assay for Fruits, Nuts, Barley, Mould and Croissants in time for the date"

I'm just writing "TWO...." onto my hand as he waltzes into the next bay.

"Mrs Jones, good morning, what are the obs like?"
Seconds that feel like hours pass before I realise he's actually asking me. I search frantically to find the Blue Obs folder and can't see it anywhere. Just as he's about to shoot me in the face I realise that on THIS ward (in the same hospital, on the same floor under the same directorate as my last ward) the obs are kept on a clipboard at the end of the bed.

"Oh errr" I flap, attempting to find the correct page before succeeding at last "Stable, Apyrexial"

"Excellent, Mrs Jones. Well all your numbers are intact so I think we can send you home"

At this moment I realise I was reading it wrong and she's actually got a temperature of 37.8

"Well she does have a temp of 37.8" I remark, trying to look like the word 'aprexial' never left my mouth "So shall we keep her in a little longer?"

If looks could kill then the look he gave me at this point still wouldn't have, because he seemed fine with it. I knew, however, that deep within his mind he was etching a mark next to my name. And not a good mark either.

07:55 "So do you tend to write in the notes after the ward round on this firm" I ask, in an attempt to work out how the fuck one is supposed to have time to write anything
"No no, at the same time" replies the reg before disappearing into another room.

08:45 Our ward round, despite it's lightning fast speeds, is only just over when the reg gets bleeped.
"Well why isn't there anyone else" I hear him snarl into the phone "But noone told me? Well that's ridiculous"...
He slams the phone down before turning to me
"Apparently there's noone to do the HPB ward round as their F1s are all in induction and there's no registrar so it looks like we're going to have to fucking do it"

09:00 I'm a little confused as to where Ben, the other F1 on my firm, has got to. I could really do with his help this morning and the registrar seems a little unimpressed to. I ring him.

"Oh Hi Geoff, I'm on call in SAU Buddy, what do you need?"
"Oh err I was hoping you'd be free for the ward round..."
"No can do, got a ward round on the go down here. Will ring you later if I'm free"

... looks like I'm on my own then...


11:00 After a long, LONG, ward round that involved running around the place like a total idiot the majority of the time, walking into side rooms containing dead bodies, and generally feeling flustered I at last get a reprieve when we arrive at my old ward to see an outlying patient.

The ward is somehow brighter and more spacious than all the other surgery wards, I realise, and lacks the air of sheer panic that saturates the rest of the hospital. All the nursing staff wave at me enthusiastically "Hi Geoff!! Nice to see you back, we've missed you" and, being as I know where stuff actually IS I can get my hands on the notes with speed. I hope, desperately, that the registrar notes that people seem to like me here and might use that to remove the many accumulating black marks against my name.

11:30 Ward round is finally over and I can at last get back to the ward to start my many many many jobs. On the way I bump into Preetha, the HPB F1 who has just been in induction. Handing over a large wad of pages with cryptic scribblings on I welcome her to Surgery with the phrase "You're on post take, here are your 50 patients"

11:40 Just as I'm about to start typing one of the billion eDischarge Letters I have to write I get bleeped. Being bleeped when not on call (and even then...), as you may have realised, is something quite alien to me.

"Hello, It's Geoff the ENtriyongfdiodjrme Upper GI F1?"
"Yes, hello" comes a voice reminiscent of a machine gun "It's Ward 313 here, I was wondering when you're going to have our eDischarge Letters done?"
"Oh I'll have them done as soon as I can, we just finished ward roun-" *click*

Probably just someone having an off day, I think to myself, all the nurses on my old ward were great.

12:30 One of the guys we saw on ward round had been bleeding unexpectedly last night and so needed his bloods monitoring regularly. He also seemed to be unable to pass urine so it was time to catheterise him.

"Don't suppose any nurses on this ward do male catheters?" I ask doubtfully
"Well Lorraine over there does but she's not on duty as a nurse today she's only working as a discharge nurse"
"Oh right"

What the FUCK is a discharge nurse? Shouldn't these people be, like, saving children's lives and not sitting at a desk ringing F1s to get them to do paper work? AGH

13:00 I've eventually found all of the necessary kit to do a catheter on this strange and unholy ward and am about to set to the task when a student nurse asks me if she can watch.

"Sure, I mean I've done one of these ever before in my entire life but why not"
"And then I'll show you how it's really done" adds Lorraine helpfully

13:20 Having successfully rammed a tube into the guys urethra it's time for me to get onto the n-billion other tasks I have to do. I bump into Preetha who has n-billion * 50 jobs to do and is looking really stressed.

"Where's the other F1 on your firm?"
"Oh he's not coming in, he went home after induction"
"Why? Day off?"
"No he just went home. I rang him to ask if he could come in and he just shouted at me"

Well that's just what you need when you're on post take and being swallowed alive by jobs. I offer to give her a hand with some eDischarges before continuing on with my own jobs and I can tell that she really wants to say no but her level of stress simply won't allow it.

14:00 As I sit in the office trying to wade through paper work I notice that the colorectal team, on which Matt now works, have been sitting around doing very little all day and can often be overheard saying things like "I can't BELIEVE it's so quiet on here". This is becoming very irritating and has opened my eyes to how annoying it must have been for everyone else when we were going on about what a doss ENT is. At the time we thought we were being amusing but I now realise that we were wrong.

A noteable exception to this doss fest is Matt himself who was seen going off to deal with a woman who collapsed over the other side of the hospital and hasn't really been seen since.

14:30 I'm bleeped by a ward in the depths of the hospital who used to give us lots of grief when we were on ENT and who, I theorise, will be even worse now. There is a lady on there that clinical support (i.e. the bloodmeister cannulator extreme pro masters) and the ward doctor have been unable to get bloods from. They wonder if I might be able to help and I explain to them that I suck at everything but I'll try. "Oh thanks, all we really need is a clotting screen"

14:35 "So all you need is a clotting screen?" I ask as I arrive on the ward "well we kind of need all the bloods". Hmmm.

To make matters worse the fire alarm is somehow stuck on "EXTREMELY LOUD CONSTANT NOISE" mode and the patients are getting stressed out. I manage to find a side room that is quiet and soothe the distressed woman about how horrific her needle-filled day has been.

15:00 After an extreme period of needling I eventually manage to get enough blood for all the tests and return triumphant to the nurses station.
"Here you are, all done"
"Oh thanks" replies the nurse "and you got a cannula in as well?"

No I did not get a fucking cannula in, as "all you needed" was a "clotting screen".

Fortunately at that moment I'm bleeped again and use that as an excuse to get out of the whole thing.

"Agh sorry, you'll have to get the consultant to do it, I'm really busy byeeeee"

16:00 Back in the office and I'm just trying to get my jobs finished so that I can start updating the crappy Upper GI list to the superbadass Visual Basic enabled one that I made on ENT. A nurse appears at the door.

"Hi, you wrote up Mrs Clarke for some fluids with 40mmol of Potassium in?"
"Yup?"
"Well I checked and her potassium is 3.5, so it's not really very low"
"Er...."
"So I don't think she needs 40 mmol of Potassium"
"Oh it'll be fine just give her that"
"Fine" She storms off.

Firstly 3.5 is the very BOTTOM END of the normal range of potassium. Secondly, you lose 40mmol of potassium every day just by default. Thirdly she has been vomiting all day and is nil by mouth. Fourthly vomit is filled with potassium. Fifthly potassium is pushed out of cells and into the intravascular space when there isn't much around meaning that her whole body loss of potassium is likely much greater than her blood tests would show. So SCREW YOU, woman.

17:00 The bastard colorectal bastards are heading home. Matt looks tired from all his saving of lives but the rest of them continue to spew lines like "I just can't believe we're going home so early, this is insane". In fairness I've also basically finished but am just trying to get my list up to date.

17:30 I've been waiting around for the registrar because I don't feel like just going home without telling anyone but I'm getting bored. I ring him but he's in theatre and as I do so I hear a voice from behind me

"Awwww bless him all on his own"

It's my favourite consultant in the world Miss Silvafox, and as she waves me goodbye I feel a whole lot better.

18:00 I head off to theatre to say good bye to the reg but before I do so I ask the nurse if there's any jobs on the ward. First she gets me to write up a massive list of regular medications on someones eDischarge (possibly for no reason) and then informs me that she just isn't going to give that bag of fluids with the potassium in.

This annoys me alot but I go to theatre and then go home anway. (On route I also bump into Sri and he gives me a hug, making everything OK).

Day 4:

My one day off before the hideous onslaught of my 8 day week begins. It is mostly filled with sleep.

Day 5:

7:30 I arrive on the Surgical Admissions Unit horribly early so that I can work out what, the hell, is going there before ward round begins (running theme eh). As I enter the doctors office (which, as the only thing I remember about SAU from being a student, had moved recently) I find Matt and Emma desperately trying to get their list in order because it's post-take day so they're taking on all the patients who came into SAU over the week.

I attempt to make smalltalk with them but they seem generally displeased with the idea so I end up just sitting and twiddling my thumbs.

08:00 The registrar turns up. I've met this guy during medicals school and many times in the mess since and he is generally a top guy and, as a result, my fear of this hideous weekend is somewhat diminished. However as he sits down at the desk I notice he looks rough.

"Mate, I am so not up for this weekend on call man, I'm knackered", he gasps at me

I suggest he tries taking 2 grams of paracetamol, my new answer to literally everything, but he sits with his head in his hands at the table looking generally sad.

08:15 The SHO turns up. I'd heard bad things about this guy from previous people who have been on SAU with him and the fact that he is late isn't a good sign. However he seems nice enough to talk to and at least he's awake.

08:30 The registrar, a locum from barbados or somewhere equally distant eventually arrives and we can start the ward round. This is just like a rerun of the previous day as I have literally no idea where anything is, including the patients and, because it's the admissions unit and therefore must be less organised than anywhere else on earth, none of the notes are where they're supposed to be and even when they are the place they're supposed to be is unlabelled so there's no way of knowing that's where they're supposed to be.

GAH.

11:00 One of the first patients that needs seeing had gone to the GP with backpain the previous day and had been ushered into hospital for immediate assessment. The fear here was that she might have something called "Cauda Equina Syndrome" which is when a prolapsed intervertebral disk squeezes you spine at a critical level and can lead to you becoming incontinent and paralysed. The test for this is to have a finger up your bum and then have various things prodded around your groin and these had all come back negative so, as is the case in hospital, she had been turfed to the surgeons to work out what's best to do.

My one and only job is to put in a cannula which she makes a huge fuss out of but it all goes in fine. As I'm talking to her to try to stop her from crying like a sissy I ask her about her symptoms and it becomes abundantly clear that nothing at all is wrong with her. The main thing that they wanted to rule out after this cauda equina malarky was a kidney stone but, given her complete lack of associated symptoms I'm not convinced.

Eventually after I finish sucking her blood out for the 4th time in 2 days the registrar comes in and immediately discharges her because she's fine. At least she's had her money's worth from the NHS eh, and who DOESN'T like being randomly fingered in the ass by a doctor?

12:30 The morning has been going well, I've put in many cannulas first time, there's a badass medical student helping us out doing amazing clerking and all I've really had to do is write down everything that the registrar says when he clerks the patients. Pretty easy and care free.

13:00 We go to clerk a young guy who's had all his colon removed to prevent him from developing a hideous bowel cancer that runs in his family. He looks pretty rough and is generally in a bad mood.

"So this young student is going to put a drip in" says the reg as he finishes off clerking
"OOooooh I don't think we like the idea of that" the guys mother replies
"Oh really?"
"Yes he's really needlephobic and the last time they tried he was really difficult and he ended up almost punching the young doctor in the face"
The registrar looks from the MASSIVE wound on his abdomen, to the colostomy bag, to his jaundiced eyes and says
"But mate, you've been through much worse than a little needle?"
"I known but I still hate them" he replies "so it'd better go in first time"

We leave the trembling student to do it, not least because he's much better than me and the registrar is far too senior for such foolishness.

13:45 Back in the doctors office we find the SHO typing up an eDischarge
"Wow! Typing up a TTO? You're a changed man!" says the reg, slapping the SHO on the back
"Well if you want to blame all the problems this department has on me just because of some things that one or two people have said then you can just fucking do that" he snarls in response
"Oh mate, sorry I was just joking"
"No, no, it's fine I know what you all think, and you know what that's why I don't want to do surgery anymore because you have to be a certain type of person with a certain attitude or you just get mocked and if that's not me then that's totally ok"

The reg spends the next 30 minutes or so trying to apologise to the guy but he's having none of it and seems genuinely pretty pissed off with the world at large. He eventually goes off for lunch at which point we realise that noone has seen the student for a while...

14:00 "I tried 4 times and I couldn't get it, he's really pissed off" says the student. "Anyway I've got to go and do some audit stuff now so I'd better be leaving"
"Audit stuff? But we need your help" says the reg
"Sorry but you know, need points for MTAS and everything"
"But you don't get points for audits on MTAS? It's essentially a complete lottery"
"Hahaha yea anyway gotta go", he finishes scared by the desperation of the reg "Bye"

He vanishes off leaving me to try and cannulate the difficult and angry guy. I fail repeatedly but at least my use of lidocaine makes him less angry.

16:00 Ben, my Upper GI companion turns up for his late shift having only realised he was on til midnight after arriving at 7:30am for the ward round. Despite this he is extremely chirpy and lightens up the place some what.

20:00 Just as the night SHO arrives to take over from us another patient arrives to be seen. Having spent the entire afternoon fucking up cannula after cannula and feeling more and more like the day SHO hates me I decide to trying and look good by going to see him.

IT turns out to be an elderly gentleman who had some pain in his foot and, when he saw the GP about it, the GP got really scared that there were no pulses in the foot and that it was about to fall off. When I go to see him he is very chirpy and, conveniently given the time he's been waiting, his foot remains firmly attached.

Now because I'm a badass, I decide to hunt down the doppler probe and do a proper exam on his foot. I find the pulses that the GP couldn't and try to do a measurement of the difference between his foot pulses and his arm pulses that gives you an idea of how good the arteries are. Unfortunately, due to him having the sugar diabetes, his arteries are made of STEEL and his blood pressure comes back at 250/190 or something insane.

Either way his foot isn't going to fall off so I assure him that a reg will come in and see him shortly and let him go home.

20:30 I head off home, feeling like I've really achieved nothing today.

Day 6:

07:15 Quite why I thought I'd take as long to get in on a Saturday as on a weekday I have no idea and I find myself sitting the car park of the hospital in the dark trying to make the most out of the warmth and comfort of my car before another day of SAU craziness.
08:15 Mere minutes after arriving the reg has managed to upset someone again. This time it was another F1 who asked what he should do today as he'd never been on weekend ward cover before.
"Just shadow the elective registrar all day" was the reg's reply, which seemed innocuous enough to me but the other F1 went storming off. When the reg eventually found him again to apologise for being rude (even though he hadn't been) the F1 responded "Yes, you are extremely rude"

Good start to the day.

11:00 The cannulas have been going terribly all day and matters go from bad to worse when the SHO asks me to just bleed and cannula an ex Intravenous Drug Addict who's come in with pancreatitis.

The guy is actually really nice, despite reeking horribly of alcohol, and is very apologetic about how crap all his veins are. Disturbingly, given that he must have had quite a few needles, he is still a huge wimp and makes quite a fuss every time I try. More disturbingly, though, is the fact he can see choice veins within a second of the tourniquet going on and is all too helpful in getting them to come up.

11:30 Having failed to cannulate the guy but having succeeded in getting enough blood out of him to send to the lab (whilst desperately trying to avoid getting it in my eyes lest I contract his bad AIDS) I now have to do an arterial blood gas. These are theoretically easy, what with arteries being bigger than veins and easier to find due to all that pulsing they do.

I stick the needle in and get blood out first time. I then have to run across the hospital to the analysis machine (amazingly called the GEM 4000). When I get to it I realise I need a password but, inexplicably, noone in the entire department has one. There are also TV crews filming for some kind of Channel 4 'Hospitals are Probably Bad' documentary and i'm excruciatingly aware of the fact I've run back and forth past their camera brandishing a syringful of blood in a crazed fashion several times.

When I eventually get the machine to analyse the blood it tells me the oxygen concentration is something like 20%. This would generally mean either a) the patient is dead or b) I took the blood from a vein. This confuses me somewhat as the blood pulsed into the syringe and looked quite brightly coloured but I tramp back to the guy and take a sample from his other wrist.

This time when I go to the machine it comes back as 88% oxygen. This is nearer normal but still isn't what you'd expect and the SHO tells me it's because I got a mixed sample and not to worry (though I fear he's secretly judging me for being totally shit).

13:00 I'm bleeped for the 100th time by a nurse on a ward in the hospital somewhere to do some discharge letters for one of their patients. I remind her that I'm the emergency on-call F1 and so I only look after people in SAU or who have come in since Friday morning. She tells me that the other F1 refuses to do anything they ring him about and so it must be my problem.

I check with the SHO that it definitely is NOT my problem before going and doing the job anyway because at the end of the day, the patients do actually come first and if stuff needs doing then it needs doing. However I do curse the name of the bastard other F1 who is not only moody but also lazy, it seems. (This is the same guy who refused to come in to help Preetha out on her first day).

14:00 One of our patients, a ridiculously stacked 17 year old who got stabbed in the abdomen by his girlfriend (yikes!) has gone into urinary retention and needs a catheter. He's desperate so I run and get all the equipment ready and return to his bed gowned up and ready to go. As I come round behind the curtains I realise he's already got all his clothes off ready for the procedure and that he has a MASSIVE PENIS. I'm starting to wonder if it'll even be possible for me to hold it in one hand while I put the catheter in or whether I'll need help and, furthermore, if I need help would it be fair to get one of the female nurses in? I mean, they're not gonna be able to resist this rippling bronze (ok jaundiced) guy with a massive penis, they're gonna end up having rampant sex with him right there in the bay and then get struck off and through no fault of their own.

Using all my strength I manage to lift the thing and get the tube passed in easily resulting in the ever so disgusting but satisfying pouring of urine from the end of the tube. (mmmm this is why you read the blog right?). I then go off to weep in a cupboard about my general inferiority as a man and down some steroids in the hope it'll make me big and strong too.

15:00 Another patient (who I like alot because as I'm taking blood he remarks 'ahh that's proper black irish blood roight there that is') needs a blood gas so I go through the rigmarole again only this time I find that the blood gas machine is broken and needs recalibrating. I go through the lengthy recalibrating process but it fails at the last step and so I have to run another thousand miles to find a different machine. It then turns out that the first machine had a problem with it's oxygen probe and so was giving spurious oxygen readouts and, therefor, I AM NOT A TOTAL RETARD.

WOOOOOOO. *does a dance* Hey now, you're an all star, get your game on go play. Hey now you're a rock star get the show on go playyy. *Party Poppers* etc...

20:00 Lots more stuff has happened and I'm generally knackered but I can't remember what it is so I feel once again like I've not really achieved anything today. Either way the night SHO has arrived so I slink off home.

Day 7:

08:00 I arrive (not ridiculously early HAHA) to find the night SHO, who's name is a cross between mine and Dave Thornback's and therefore must be cool, generally bopping around and singing songs. She has, apparently, had a terrible and busy night and is completely knackered but yet is extremely perky.

"Don't worry mate, I've just gone a little bit delirious after my night shift is all"

This delirious nature doesn't make her any less ruthlessly efficient, it turns out as the ward round begins and  her ability to produce beautifully neat ward round notes at high speed is even more impressive.

At the point that I'm beginning to wish I was her she sticks a hand down her bra and pulls out a lip balm. Noticing the astonishment on mine and the SHO's face she responds
"Oh yea, I keep all sorts of stuff down there. Massive boobs you see, really useful"

Sorry Kish, you're great and all but I have a new goal in life: Become this SHO.

09:30 The registrar is in theatre with the consultant so it's just the SHO and I doing ward round. As we come to the bed of one particular patient (whose potassium was 2.3 yesterday and whose nurses kept ignoring our 'Saline + Potassium' prescriptions, much like EVERY nurse these days???) we find he in tears screaming at one of the nurses for being a 'bitch' and that she 'never wants to be near her again'.

The SHO does a swell job of chilling her the fuck out and explaining that we do really care about what's wrong with her and want her to get better (even though she has basically a cold). He also explains that we just need to get her potassium back to normal and then she can go home and eat and be merry.

10:00 I'm catheterising yet another guy and am finding that I've had rather enough penis for one weekend. Furthermore this guy is dying horribly and his entire family have left the room while I do the procedure. He doesn't really like the idea of the catheter and is trying feebly to resist but I'm easily able to overpower him. This doesn't make me feel very great, however, despite the fact that it is in his best interests and we have his families permission and I'm glad when I finally get everything in place.

10:20 A nurse appears at the doctors office to tell me that the catheter is overflowing. Fortunately the day SHO (who I must say has been really helpful and nice this weekend) says he'll have a look and I'm saved from going back there when the reg rings and asks me to come upstairs for a ward round.

10:30 I arrive back on SAU after running up 3 flights of stairs to find that the reg had to go back to theatre and go to assist the SHO with the recatheterisation of the poor guy. The old catheter comes out easily and isn't tinged with any blood proving it was in the right place but for some reason the guys penis has swollen up massively and is a bit like a balloon.

The SHO tries for a long time to get a new catheter in but it's just doing weird and unusual things within the guys penis so we go and ring the urology reg. He tells us that all catheters will overflow in this guy and that there's no point, which absolves me of looking more like a retard than I already do (if possible) for the first one failing but also means we don't have to spend any more time shoving things in his penis. Both of these points makes me very happy

11:00 Because the catheter guy is for palliative care only we have got the palliative care nurse to come and review him. He decides that the poor chap needs a variety of badass drugs (one of which is HEROIN) but, due to stupid stupidness, he is unable to prescribe any of them himself and so I have to do it. This is fine by me because he's been so helpful and I feel for the dying guy but over the course of the day it comes back to bite me in the ass a million times because, due to the illicit nature of these drugs, pharmacy are very twitchy about giving them out.

15:00 I'm back with the catheter again, this time is a ridiculous demented guy who has a bowel obstruction. This guy is super demented, like he can't even respond to you, all he can do is laugh in a really disturbing way and lock his death-grip hands on you. I enlist a nurse to come and grab his hands whilst I stick the tube in because I fear for the bones in my wrists if he grabs onto them any harder and manage to pass the catheter whilst he laughs insanely.

Next up is an NG tube. For this I need a nurse to hold both his hands and another to try to feed him water to make him swallow so the NG tube wont go into his LUNGS. This proves totally impossible giving his mental state and I begin to wonder really what the point is. If (and when, thanks to the Alzheimers that my dad's side of the family are so fond of) I end up like this please kill me. I don't mean it in a throwaway "I'm young I have everything to live for and can't imagine it" type way I mean seriously. I would not class myself as a human being in that state, more a machine for eating and pooing. What is the point of being kept alive when you don't know who you or anyone else is, you can't communicate with anyone you're lying most of the day in your own urine and faeces and noone comes to visit you. This isn't like someone who's had a stroke and they can't communicate, this is someone who literally doesn't have the mental function to do so. Others might want to live like that but it's not for me, thanks, not for me at all.

16:00 Low potassium lady is unbleedable. In fact one of the clinical support workers who's being doing bloods for 10 years can't do it. To this end I decide to do an arterial gas on her just to find out if her potassium is normal yet.

It is not. It's gone down.

The SHO isn't too worried about this and decides it's all an artefact of the fact I used the blood gas machine and not the lab. He promises to bleed her later in the day but I go and write her up for some extra potassium just in case (if the nurses will frikking GIVE it that is).

17:00 Pharmacy bleep me for the n-millionth time about the crack cocaine I've prescribed the dying guy. It turns out that not only do I have to write it out in words and numbers on the computer, in duplicate but I also have to hand sign all the printouts AND sign another form to give to the local pharmacy.

I ponder how it is, exactly, that doctors ever get addicted to the prescription drugs that people think they are always getting addicted to. It seems to me to be frikking IMPOSSIBLE.

18:00 The bloods come back on low potassium woman. They are just the same as the gas I took. Wooo. Furthermore the potassium I gave her in the mean time means she's probably not dead as she otherwise would have been. Woo.

However I also learn that the consultant has sent her home. Hmm.

19:00 Ben has ordered in chinese and I eat it all in about 15 seconds, he also refuses to let me pay for any of it even though he was 0% banded for the last 4 months and has probably been living on straw.

20:00 Home at last. Though there is little victorious about this as I basically failed at everything all weekend, I'm really knackered and I have another 5 days to go of post-take. Normally post-take is where the team under the consultant who was on at the weekend or during the week takes over all the patients who came into SAU. This is usually pretty stressful for everyone involved. However in this case not only is the team of the consultant the same team who were on over the weekend but also it's not so much a team as just me as everyone else is on holiday. Furthermore the consultant is on again during the week and so I have another barrage of patients to look forward to on the Friday.

EXTRA CHRISTMAS BUMPER EDITION:

Because I will have no time to write about last weeks insane and horrifying post-take week I'm putting an addendum on this blog.

Basically it was hell. My bleed went off on average every 15 minutes but many times it just went off 5 times in a row. The nursing staff were unsupportive and rude. The patients were needy and annoying. I nearly went completely berserk about 3 times due to minor annoyences that built up and built up (like being bleeped to do an eDischarge IMMEDIATELY only to come onto the ward to find noone knows where the paperwork is or that the patient is actually staying in until the next day). However I was helped out massively by a couple of people and all the surgical F1s were generally very nice and made me want to kill everyone slightly less.

I also helped out the poor ENT F1 in the evenings because they no longer get the wonderful Sri handholding that we got due to budget cuts and, furthermore, the other F1 had been horrible to her during the first day so I felt like she needed some help.

Everything else is a blur of bleeps and hectic running around the hospital and I'm glad it's over. There's only another 4 or so to go before the end of the attachement (AGH).

Anyway may everyone have a lovely christmas and I'll see you all in the new year (except I won't actually see you probably and the next entry will be before the new year but whatever).

Tune In Next Time For Another Exciting Episode Of 'Trust Me, I've Got Scary Night Shifts And I'm Scared'