A week in the life of an SAS Anaesthetist
May 2024
Monday
A super early start as I rise for breakfast at 03:30 to fuel for the first day of Ramadan (a month of abstinence from food and drink from dawn until dusk) with my two bleary-eyed teens, followed by prayer and recitation of the Quran, then back to bed for a couple of hours of sleep before the daily routine starts.
Sleep is premium in Ramadan as we engage in additional prayer, particularly at night.
Fortunately, it’s a non-clinical day for me so I work from home.
At 09:00 I begin work on a presentation for our monthly departmental Continuing Medical Education (CME) programme. Fortunately, most of the groundwork has been done and I just have to create PowerPoint slides – cue my 16-year-old daughter who whips this up in no time and all that’s left for me to do is edit and refine!
After a break for midday prayer, I move on to the next task – filling in a form (I hate filling in forms, but this was different) to volunteer for GEM (Gaza Educate Medics). I attended a webinar last night hosted by a group of like-minded individuals who were working together to support medical students and medical education in Gaza. They recognised that medical professionals would be the backbone of any healthcare system recovery efforts in Palestine and sustainable medical education was key to this. I was humbled to be in the ‘presence’ of esteemed academics from Europe as well as Gazan doctors and medical school faculty who were experiencing first-hand the atrocities of war in their homeland. It was great to see local (UK) medical students in the meeting coming up with innovative ideas for internet access and support for their Gazan counterparts, most of whom had left to neighbouring countries. It was also heartening to note a good showing of clinicians from Aberdeen thanks to the efforts of one of my colleagues.
At about 13:30 I receive an email about a referral for Electroconvulsive therapy (ECT) for a patient on my list tomorrow, the indication – malignant catatonia. I’m aware of conditions like malignant hyperthermia, malignant hypertension, neuroleptic malignant syndrome but not malignant catatonia – so some reading was in order!
This took me up to late afternoon prayer followed by kitchen duties in preparation for breaking fast at sunset. Many hands make light work, and these were certainly forthcoming in anticipation of this time. I looked forward to a lovely cup of coffee!
The build up to bedtime was prayer, contemplation, and thoughts about the challenges my new patient posed for me the next day.
Tuesday
Tuesday’s schedule was ECT in the morning and Orthopaedic Pre-assessment Clinic (POAC) in the afternoon.
My morning began with a visit to the local Psychiatric hospital to assess Mr M, a 64-year-old with a background of bipolar affective disorder, chronic kidney disease, diabetes insipidus secondary to lithium treatment and who had had developed neuroleptic malignant syndrome 2 years ago following the addition of an antipsychotic to his regimen. He was returned from ICU late the previous day, after being admitted with features of neuroleptic malignant syndrome resulting in in acute kidney injury secondary to rhabdomyolysis from muscle rigidity. He had been pyrexial, but these ‘malignant’ features had settled, unmasking severe catatonia. I found him on the floor of his ward in an awkward lie; it was hazardous to nurse him in bed. It was not possible to make any sort of meaningful assessment except to conclude that he certainly required ECT.
It took an entire team to bring him down to the ECT suite, notwithstanding the fact that a hoist was required to lift him off the floor to start with. He was dry, with no intake at all overnight; particularly concerning in view of his acute kidney injury. This also meant a departure from the standard recipe of Propofol and Suxamethonium for this procedure, the latter substituted with Rocuronium, and reversed with Sugammadex.
At the time of writing this, Mr M’s condition had improved significantly, to the point that he had managed to down a glass of milk prior to his ECT session which was thus cancelled!
Following a later than normal finish at ECT, I made my way up to the POAC, concerned that I’d kept patients waiting. However, this was not the case as all I had was a pile of patient packs to go through. I’d much rather have patients to see as this is where significant differences can be made, with shared decision making put into real practice. I’ve recently completed a Postgraduate Diploma in Perioperative Medicine, and I’m excited about developing and enhancing our local services.
Alright, so I embellished the ‘pile’ of notes – I managed to get through them with enough time to review pre-assessment notes for tomorrow’s gynaecological list and arrive home to start the preparations for breaking fast.
Wednesday
CME morning, online so I joined from home.
The Morbidity and Mortality (M&M) section included cases of misbehaving BIS monitors causing consternation for anaesthetists but no harm to patients, and a harrowing paediatric resuscitation case in a child with Moebius syndrome and difficult airway. Well done to the team who managed this case, and with a good patient outcome! This led to discussions about multidisciplinary anticipatory plans for management of patients with known difficult airways in the interests of their safety.
Professor James Grieve (University of Aberdeen) then delivered a very informative and witty presentation entitled ‘The Forensic Pathologist and the Anaesthetist’.
This was quite an act to follow with my presentation detailing an audit and findings of the clinical reasons for day of surgery cancellations of patients who were pre-assessed at our hospital. This was in collaboration with a Specialty doctor colleague who convinced me it was worthy of an abstract submission for the Association’s Winter Scientific Meeting. She was right as it was accepted and also shortlisted for a poster submission.
The meeting continued with further Paediatric prowess as the team described how they successfully performed a spinal anaesthetic in a neonate of 39 weeks corrected gestational age, with a background of chronic lung disease requiring bilateral inguinal herniae repair. Watch this space for further exciting developments!
There were five patients on the afternoon gynaecology list. I confess I don’t enjoy lists for this specialty, but the major consolation was that I got to work with a Consultant colleague. As a Specialty doctor, we work independently and solo on most lists, sometimes blessed with a trainee, so this was certainly a bonus, made all the better as my colleague is a genuinely lovely person and an excellent anaesthetist. In fact, she is so thoughtful that the next time we worked together she brought me a gift of delicious dates to break my fast with!
The list of mostly young, anxious patients went well. There was an 81-year-old patient whose husband had recently died in the Post Anaesthetic Care Unit (PACU). She was typically stoical, but my colleague took the time to reassure her and allay her fears. Subsequently, when her procedure was complete there was no space in PACU, so she only spent a short time there.
Unfortunately, as we expected, the last patient was cancelled, as the list overran.
I returned home to the usual routine and packed a bag for my trip to Glasgow the next morning.
Thursday
I arrived at the station ready for the 09:44 train to Glasgow for the Association’s Scottish Standing Committee (SSC) meeting as the SAS representative. I planned to be quite productive on the two-and-a-half-hour journey, which I did accomplish to a degree.
I was, however, distracted by a book entitled ‘Sherpa’. I had bought it a while ago but was waylaid by my Final FRCA examination, and it had been relegated to the nether regions of my desk. Having survived Mount Kilimanjaro and Mount Toubkal last year (I say ‘survived’ because I certainly did not conquer them – altitude is a beast and vomiting your way up a mountain is not heroic!) I turned my sights to Nepal and aim to trek the Annapurna circuit next year - I will have to train very hard for this! Sherpa is a fascinating read into the rich history of the Nepalese who are capable of phenomenal endurance at altitude and risk life and limb every season to set up routes for climbers in the harshest of environments! I couldn’t put it down.
I arrived at Glasgow at 12:20 and taxied to the Village Hotel, the meeting venue. On arrival, I met Andrea Harvey, the Convenor of the Committee, and my work colleague – it turned out that we had been on the same train! I checked in and made my way to the meeting – this was only my second. It was a very productive session, the face-to-face format certainly contributing to the flow of discussion.
Key topics were raising the profile of the SSC to its members, communication and dissemination of patient safety matters in Scotland, advancement opportunities for SAS doctors and roll-out of the Specialist post within the region, and plans for the SSC’s 25th Anniversary celebrations. The meeting concluded with a photo op.
The team reconvened at 17:30, this time at the Ox and Finch restaurant where we were treated to some amazing food, with fabulous company.
We walked back to the hotel in the pouring rain (thoroughly enjoyed it!), checked in on the home front and retired for the night.
Friday
The Association’s Core Topics meeting today, a full day of presentations and learning.
It was a good opportunity to catch up with colleagues from work whom I don’t often see, and to network with others.
Given my interest in Perioperative Medicine, this session was valuable, particularly for thinking about how to enhance and improve interdisciplinary communication, patient engagement, and management of patients with cardiac co-morbidities.
The highlight of the day was the powerhouse, Dr Kathleen Ferguson’s presentation of the Association’s guidelines for safe drug handling. The statistics reflecting the incidence and nature of drug errors was staggering! Dr Ferguson has a talent for engaging with her audience and she certainly did so on this occasion. Dr Ferguson is a figure I aspire to and consider myself privileged to work alongside her.
The travel back to Aberdeen in the early evening was relaxing after a busy couple of days. I took the time to schedule our monthly departmental Senior Staff meeting on Teams, in my capacity as honorary secretary. Queries and requests for agenda items quickly followed and I dealt with these before settling into further chapters of Sherpa for the rest of the trip home.
Ruwaida Khan
Specialty Doctor (Aberdeen Royal Infirmary, Department of Anaesthetics, Aberdeen, Scotland)
X @KhanRuwaida
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