Back to work today and we were post on-call. Unfortunately having had two days off meant I didn’t really know a lot of our patients and in addition to this a bunch of new sick patients.

Having to drop our son off to school first – Red Nose day today – I got to work around 8.20am and the ward round of course had already started.

When I start my days late I feel out of tune with everything. The list looks slightly different as I didn’t print them and therefore they are not the same.

Luckily we’ve had an SHO with us today which is an immense help as the surgical SHO’s are great.

Finishing the ward round around 10.30am having been to 6 different ward as our patients are placed all over the hospital due to the usual bed crisis within the NHS. We met with the incoming on-call surgeon – who is also an UGI consultant – and went through the list and made her aware of a few patient (unwell or patient who might need intervening during the weekend).

The F1 – who was on-call during the week – the UGI F1, our SHO and me divided up the jobs from the ward round and started getting on with is. Especially as the SHO and I had to leave around 4pm today – as usual I’ve had to collect our son from school.

I went to the private ward for my first job to discharge one of our patients who stayed for roughly a month due to gallstone pancreatitis. The discharge letter hadn’t been prepped so that had to be sorted. Her discharge medication were all over the place as we had to temporarily stop some of them due to her having an AKI (acute kidney injury) and an admission INR of 10(!!!!!!!). A normal INR range would be between 0.8 – 1.2. If you are on warfarin the range is higher depending why patients are taking the medication. It never should be 10 as this is way too high and need to be reversed with Vitamin K.

Once her INR had normalized she was placed on treatment dose Enoxaparin whilst an inpatient as we were planning to surgically intervene.

In any case her Warfarin needed to be restarted with bridging Enoxaparin to home with (Usually until the INR is in therapeutic range) and an INR clinic appointment on Monday. A small bottle of Oxycodone was dispensed and I did ask the GP to review her analgesia next week.

That was just one of the jobs I’ve had to sort out. Of course my pager didn’t stay still during the shift and had to be dealt with as well. Depending on the urgency quicker rather than later.

Around 2pm we met up as a team and checked what is still outstanding and checked blood tests, scan report and endoscopy reports. We also had to put weekend plans on our system so that the weekend on-call team knows what is going on with the patients. That is important so that the weekend ward round can be done swiftly as it usually takes until at least 11am – 12pm due to the sheer number of surgical patients.

Before leaving just after 4pm I requested all blood tests for our patients for the weekend and placed them in the corresponding trays on various wards.

After coming home at around 4.45pm I’ve had a quick shower and collected our son from the after school club.

I though something was up when our son was running towards me with his school stuff in his hand. I usually have to “drag” him out of the afternoon club as most of his class mates are there as well and they having a good time.

The person running the club is employed by the school and is a really nice guys – young and a bit naive – but a nice guy.

He then took be to the side and explained to me that our son had punched kid however he wasn’t sure how it actually happened. Both our son and the other child were playing and the next things was that the other child came in (play area just outside their class room) with his mouth bleeding.

I asked if the other child was okay and if our son had apologized – kid fine and our son apologized.

On the way home I tried to get to the bottom of the issue and casually ask how our son’s day was. “Fine” was the answer. After probing a bit more he started crying (I haven’t even told him off yet) and he explained to me he didn’t want to tell me.

Revealing to him that I already knew what happened he then told me that they playing a bit rough in the playground, the other child “hit” him, he blocked (like he learned in martial Arts) and then “accidentally flicked his hand forward” (the hyphenation is obviously not how it sounded when he explained this) and punch the child. He even was showing me what he did.

I did tell our son off for his behavior and trying to tell him that defending himself is obviously find but he needs to be careful where he uses his Martial Arts stuff (he is currently only a blue with white stripes belt) but obviously can cause some damage. I am pretty sure they telling them in Martial Arts classes to be careful with what they learn and the whole ethos which comes with Martial Arts.

The other boy is in our neighbors daughter class (a year higher than our son) and therefore I just went across the road to find out a bit more about the boy (we do have some rough families/kids in our school). Our neighbors told me that the boy is usually ok but plays a bit rough at times.

I was in two mind about what happened at school. On one hand I was happy that he can defend himself and potentially won’t get bullied. On the other hand we also have the duty as a parent to enforce kindness and don’t be bullies ourself. A fine line to walk I assume.

When my wife comes home I’ll have a discussion with her about it. I think our son is more worried how she is reacting to the news.