Train your trainees

I’ve been spending a lot of time in labour ward anaesthesia this past month. It’s great, because I get all the gratification of the caesarian sections (I remember it well from internship), without having to wade through blood and amniotic fluid and human excreta myself.

This tweet in part inspired this post.

Another thing I remember well, is the tension in theatre when the intern is cutting. I had such difficulty getting my ten caesarian sections for our logbook signed off, because so few seniors were willing to let an intern cut. It’s not only the obstetrician – often, it’s the theatre nursing staff. To be fair, nobody likes to be scrubbed in for a routine caesarean that lasts ninety minutes. Other times, it’s the anaesthetists. Because nobody likes to worry that their spinal anaesthetic might wear off before the surgery is over.

I have had a taste of the same with my new position, too. Not having done anaesthesia in four years, there is a lot I have had to relearn. My “teachers” have been great, and I seem finally to be finding my feet, but there have often been grumblings from surgical teams when I was slow. As an intern, I might have minimised myself and declined to perform the procedure. But now, I need to learn, and quickly. So I have been pushing back harder (when not to the patient’s detriment) – and to my new colleagues’ credit, they have supported me.

Check the replies on this tweet – they made me feel so much better.

Having experienced this, I will always be the annoying medical officer who encourages the intern/student/newbie to perform procedures. Not because I think I’m so wonderful, but because I want trainees to feel as nurtured as I have felt these past few months, and not as burdensome as I sometimes did as a student and an intern.

Sometimes, I think clinicians forget that they were inexperienced and under-qualified juniors once, too. There is nothing admirable about learning to place an intercostal drain on YouTube, without senior supervision, as many of us like to brag. That is a sign of a failing system. We should be taught and guided by others with experience. We deserve that. Our patients deserve that.

I also know that it is a system that fails not only interns. I know that demoralised doctors have little interest in training juniors. (But that is a discussion for another day.)

Interns who are not competent become dangerous medical officers, wherever they may go for ComServe. They have both the right and the responsibility to be trained. We have the responsibility to ensure that they attain their very best, even if they are afraid while doing so. We do it to pay forward the teaching we have received. Or if we were not so fortunate, we do it to improve where others failed us.

Train your trainees. It kind of goes without saying.

Listen to me, Examine me, DIAGNOSE ME!

I haven’t even been a doctor for six full months but I’ve noticed something:

I often like things my colleagues don’t.

On O&G, I loved my clinic days. Antenatal Clinics were awesome because I could show mommies their baby’s heartbeat, or I could pick up on potential dangers and do something preventative about it, or I could pick up that they needed admission, or I could just allay their fears. We often stayed late because the rule is that nobody gets sent home without being seen.That was the only thing I disliked.

I enjoyed Gynae Clinics too, even though most of my colleagues hated them. They were more challenging, took more time to get used to, and had a lot more specialised problems. But I enjoyed it. Infertility workups and abnormal vaginal bleeding workups and don’t forget those critical patients often actually had a ruptured appendix but since they had a vagina “it MUST be something gynaecological.”

via xel - at Deviantart
via xel – at Deviantart

Continue reading “Listen to me, Examine me, DIAGNOSE ME!”

Stories from the Paeds Slate

Anaesthesiology is hard, guys. And paediatric anaesthesia even more so. But I really like my days on the Paeds Slate because the theater is out-of-this-world amazing. Everything is in stock (well, mostly) and the nurses are out-of-this-world competent and everything is just nice.

We gassed for a simple inguinal hernia repair and did a caudal block for post-operative pain. Even the best caudal blocks apparently don’t ALWAYS work so when the baby awoke he cried. Although I have my suspicions that he was crying from hunger and not pain. Anyways, his mom came running to console him, and she was crying too.

card-8709866-back Continue reading “Stories from the Paeds Slate”

Burns Patients

They come in all shapes and sizes. Little and bigger. Some are freshly burnt, the raw and sloughing flesh tender; for others it is just one more in a long line of surgeries to restore structure and function.

The scarred flesh tells stories of multiple skin grafts. IV access is a nightmare.

Types Of Burns

Some of them are just babies. They come into the operating theater wrapped up like little mummies, barely able to flex their limbs. They give weak cries, drugged up on sedation and analgesia.

We search for patches of in tact skin to attach electrodes and stickers. Continue reading “Burns Patients”

Surviving Anaesthesiology – Only Just!

I knew from the beginning that Anaesthesiology would be an incredibly difficult rotation for me. It is nothing like Medicine and nothing like Surgery, yet it encompasses both.

I’ve given patients medicine before, but never had to use complex equations to do so. I’ve done lumbar punctures, but never had to inject something into the spinal canal. I’ve administered nebulisations, but never a vapour that would render my patient unable to maintain his basic life functions. Continue reading “Surviving Anaesthesiology – Only Just!”

Redhead Anaesthetics

On Anaesthetics Call recently, we were administering spinal anaesthetic to a female patient for Cesarean section. She was a friendly redhead who reminded me a lot of Eleanor from Rainbow Rowell’s Eleanor & Park. She told us a lot of things, like that we would have to take the para-median approach to the spinal (we didn’t need to) and how it was impossible to get an IV-line up on her hands (it wasn’t), so when she told us that she was resistant to anaesthetic, we felt kind of resistant.  Continue reading “Redhead Anaesthetics”

Lessons from Anaesthesiology

I’ve been devoting three and a half loooong days to Anaesthesiology. It’s the big exam tomorrow. You might recall that I struggled a lot with this subject at the time of the class test. Well, I ended up doing pretty alright in that one. So the pressure is ON. As is my habit, I’ve managed to extrapolate some interesting (but less useful) knowledge from between the lines.

Continue reading “Lessons from Anaesthesiology”

Ellemenopea

In my first year we had quite a difficult Pharmacology course. It was well-known to be the course most often failed by first years and we were freaking out. We asked one of the professors for advice, and in his distinct German accent he said this:

It wasn’t really what we wanted to hear, but it was the truth. It worked. It’s probably the only best advice I’ve ever received from a lecturer.

If only I knew then that basic pharmacology would be nothing compared to Anaesthesia. It’s like advanced pharmacology.

I’ve been applying bum to chair and fared well… I just wish I’d started sooner. I’m still not certain that I’ll get through everything before the test.