30

The following 30-hour marathon takes place between 5.30am (14 February) and 12.30pm (15 February).

6.00am - Leave for work.
6.30am - Start clerking patients.
7.15am - Patient came in for epigastric pain TRO acute cholecystitis. Amylase 2478. Acute pancreatitis! Quickly scramble with MO to work out our management plan.
7.45am - Another surgeon replacing my consultant comes to review patients. Changed the Ranson criteria to modified Glasgow criteria. When everybody (even the MO) did not know what is the Glasgow criteria and its significance, he called all of us @$$h****, and asked how in the world did I pass med school.
9.15am - For some reason, today there are only 3 of the usual 5 people in our team. So with 1 patient who needs to rush to the scope room accompanied by a houseman, 3 patients who need to be discharged, nurses bugging you for bunged IV drips and bloods to be taken, the pancreatitis patient who needed an ultrasound etc, the surgeon asks 2 of the 3 to go down to clinic immediately coz it's overfilling with patients and the 5 housemen rostered for clinic are missing,(obviously not possible, ward work needs to be done 1st).
10.10am - The usual routine of being yelled at by the radiologist.
10.25am - Cancer patient A needs to postpone chemotherapy due to electrolyte imbalance. Palliative care unit not picking up the phone.
10.26am - Cancer patient B needs an oncology opinion regarding her chemotherapy due to neutropenic sepsis. HSI not picking up the phone.
12.15pm - A patient previously discharged after a Hartmann's procedure got readmitted for wound breakdown. The ward is filling up.
12.55pm - Just when you thought you have finished the work and are about to grab a quick lunch, the paediatric ward upstairs called. As the neurosurgical HO on call, need to review a young kid who suffered a temporo-parietal haematoma after a fall from 1 metre supine onto the concrete pavement while at the playground.
1.45pm - Rush back to the ward to review patients for afternoon rounds.
2.35pm - Afternoon rounds start.
3.15pm - Our consultant surgeon came. Learnt a lot from him, though got grilled a lot also. Asked me to be more confident.
4.15pm - Apologised to head of department who happened to be in the ward, for failing to trace his patient's histopathological report. Simply did not have the time.
4.40pm - Just realised that the next day's on call roster has not been drawn up.
4.45pm - Patient suspected anastomotic leak post-reversal of Hartmann's, planned for CT gastrograffin. Rushed to take consent and fill up forms.
5.15pm - Patient who came in earlier for wound breakdown had seropurulent discharge when sutures removed. Surgeon was initially worried about faeculent material resulting from fistula.
5.45pm - Family of a patient who has recovered from an upper GI bleed due to a gastric ulcer demands that you allow her to be discharged as she has been feeling anxious and uneasy with her hospital stay, though you wonder how to break the news to them that you were actually awaiting medical opinion regarding beta blockers for her sinus tachycardia, and psychiatry review for her apparent symptoms of low mood, poor eye contact, symptoms of persecutory delusions (bed has electric shock) and hearing voices of children playing nearby. Eventually no psychiatry condition elicited, allowed AOR discharge.
6.30pm - After the tests were planned, confirmed, and everybody has gone home, patient who was planned for CT gastrograffin mentioned that she had the abdominal pain because the nurse clamped her CBD. She felt better after its release. Endured a scolding from a pissed off MO to just do what the boss ordered when asked opinion to cancel the CT.
7.00pm - Ward work done. No time for dinner. Grabbed a bun and start Neurosurgical HDU night rounds.
8.15pm - Wondering what are all the PEEP/SIMV/CPAP measurements which the consultants and lecturers all dismissed as not important for our level during medical school..
8.30pm - 8 ABGs to be taken, 4 turned out to be VBGs.. *swt* have to re-do..
10.30pm - Night rounds at male and female ward upstairs..
3.30am - Finished night rounds. Felt like sleeping in one of the ward beds. Blurring of vision sets in (hungry and running on 2 cans of coffee) :p
4.30am - Patient from Segamat suspected intracranial bleed. Inserted CBD. Patient decided to urinate before CBD could be secured with balloon. CBD was shot right back out of his urethra, followed by a fountain spray of urine. What a mess..
5.55am - Half an hour more before my presumed end of neurosurgical call (and freedom) when the HDU phone rang. Please come upstairs to neurosurgical ward female, a patient chose this moment to go into asystole. CPR for over half an hour and had to accompany patient back to HDU..
7.30am - Start morning rounds (despite it being public holiday)
12.30pm - Finally able to go home.