A day in the life of an anaesthetic registrar
Natalie Mincher, ST6, at the Royal Gwent Hospital, Newport, Wales, shares a typical day with us.
Morning has broken
The alarm wakes me at 06:00. I lie there contemplating whether I really need this job. Maybe I can save enough money by living off the land Good Life style, cancelling Netflix and sewing my own clothes from hemp?
I get up and put the kettle on.
Long day today, starting with a big elective vascular case. No need to worry about that though because I stayed last night to see the patient and spent a good hour swotting up on the finer details of complex open aneurysms. I'm ready.
After parking in the next county and walking in from the pouring rain, I grab my scrubs. Today's selection is the same as yesterday. One size fits none. I decide that I can style out pink bottoms and an orange top with sleek to the cleavage area and head to theatre four.
'Bad news, no ITU beds. Aneurysm is off.'
Noooo!!! This was going to be my CBD extraordinaire. Mr Jones is such a lovely patient too.
'No beds for non-urgent electives either. We are helping with CEPOD.'
This isn't terrible news. I love the emergency work. It's why we came into anaesthetics, isn’t it? The thrill of the thio-sux-tube (or propofol-roc for those born this side of 1985).
First up is a six-year-old boy for an appendicectomy. The bread and butter of anaesthesia. I visit him on the ward, chat to mum and dad, and explain about the hedgehog milk (it prickles!). I even remember to prescribe EMLA.
'Have you got any questions for me Joshua?'
'Yes. Why have you got hands like skeleton’s hands?'
I love kids.
With Josh safely in recovery it's off to see the next. A lovely elderly chap with an incarcerated hernia. He lives alone, he tells me, since his wife passed away. He describes to me how he cared for her and how her favourite flowers were peonies. I smile and tell him I will see him soon.
'Thank you, nurse!' he calls after me. That'll do.
At the lunchtime meeting I'm presenting a case. I ram a pork pie from the kindly drug rep into my mouth, listen respectfully to her chat about the latest in transdermal analgesia and hit the PowerPoint. It goes OK, I think.
No one seems to have noticed that I'm not the world leading expert on Brugada syndrome. As long as no one asks any questions.
Returning from lunch I’m asked to go down to resus. An out of hospital arrest is en route. I get there and set up, writing 'GAS' across my plastic gown in marker pen. Two minutes later our patient arrives. She is grey, pale and asystolic. The team set about their roles like clockwork. I intubate, the others site venous access, give adrenaline and time cycles of CPR as a scribe writes it all down. This one we do not win. The team leader asks if anyone objects to stopping and thanks us all. Like always we pick ourselves up and head on to the next job.
The consultant and I crack on with a toe amputation. It takes me three attempts to get the spinal in and I start to question my own existence. Once the patient is on the table the consultant sends me for a much-needed coffee. The customer in front of me orders a small, decaf latte. I ponder what the point of that is and chug down my flat white with an extra shot.
The emergency call
At 17:00 I collect the on-call bleep. For a while things plod along. There's a PCA to refill, an epidural to review on the ward and a patient with difficult veins needs a cannula. The CT2 and I decide to divide and conquer. I always feel the absolute business when I bang a Venflon in on the ward so I volunteer. Unjustified when it's purely all down to practice, but I'll take these small victories. As I'm popping the Tegaderm on my bleep goes off.
'PROCEED IMMEDIATELY TO RESUS.'
I hate these calls! I'm running now, imagining the airway from hell or a sick baby… it's a ruptured AAA. This I've done before. I know the drill. My junior colleague is there already and I see the look of relief in her eyes. Your first one is always memorable and terrifying. I forget to tell her she's doing a great job and ask her to phone blood bank while I call the consultant.
The patient arrives in theatre at the same time as the boss. I realise I'm giving her the same look of relief that I'd witnessed in A&E. In a couple of years that will be me. That's a scary thought. The patient has an unexpected difficult airway. I put my hand out to the right and the ODP (which I believe is Latin for guardian angel) hands me the video laryngoscope needed for the job.
As a rule of thumb, if you’re ever unsure of which bit of equipment you need, it's usually the one in the ODP's hand.
This one we do win. At least, we get them as far as ITU and hand over the reins. I apologise to the nurse about how tangled all the patient's lines are for the 4,276th time this week. She smiles and says she will sort it.
It's now past the end of my shift and time to go. I'm dog-tired climbing into my clapped out old Golf GTI (#MoetMedics!). An exhausting but great day is done and I think the team did some good things today. If only we could do it all again tomorrow.
What’s that? We can? Marvellous. Natalie Mincher ST6, Royal Gwent Hospital, Newport, Wales (All cases included are fictitious).
Article originally published in Anaesthesia News, June 2018.