Currently with long hours working (mostly 7 – 7) it does have an impact on your sleeping habits.

Getting up early to be ready and leaving for 6.50am and then a full day ahead of problem solving is tiring.

In all fairness it would help if I would go to bed at a sensible time and not around midnight.

This week was just the end of the tidal wave which swept through our department for the last 3 weeks due to our on-call commitments.

Monday was sort off okay although one of my registrars was on-call over the weekend and did some surgical consults for some medical patients who all ended up on our list.

All of them had clear plans from the weekend to be executed on Monday morning however all those medical teams paged us all morning for more consultations. Frustrating when there is a full plan in place.

However, I do get it as we asking them to do something or to look for something they’re not really know about and that can be scary.

Over the weekend one of our patients died – who received a poor diagnosis and prognosis sometime last week however that fact that the patient went downhill so quickly came as a surprise.

The elective list on Monday was fine and the majority of patients went home the same day.

The medical patients with the plan in place from the weekend needed some liaising with various other teams – predominantly with Interventional Radiology and Endoscopy.

The challenging one was the endoscopy procedure as the patient was 1 year post Whipple’s procedure and it looked like that the afferent limb was dilated. The patient was jaundice, feeling nauseated and can’t keep food down.

So, gastroscopy couldn’t find the reason for the patient’s symptoms and that was mainly due to the fact the gastroenterologist struggled to perform the procedure. They did see some ulcerations and suggested PPI’s – well the patient was already on them.

Following a review of the imaging, the gastroscopy and a discussion with our tertiary centre (BRI) one of my consultants review the patient on the medical ward and came up with a plan.

Repeat OGD and sent placement (or more likely two stents – one either side of the limb) and see if that makes any difference.

The jaundice needed to be addressed as well and if the reason for the jaundice is recurrence then a metal stent would need to be placed.

The above plan took a day to sort out therefore happened earlier and by the time I left the hospital the patient still not back on the medical ward.

Another patient was referred to us from the surgical on-call team who has had an oesophagectomy done a while back. Presented with emesis, pain and unable to keep any food down.

CT was requested which showed that the stomach is in the chest cavity (not that unusual after oesophagectomy) but in addition to this the majority of the small and some large bowel are also in the chest with a blown up stomach which means it can’t empty itself.

Placing a nasogastric tube is vital but it was very poorly tolerated by the patient therefore needed several attempts prior the referral to us.

Unfortunately, the nasogastric tube expelled and needed a new one. The patient was not happy about it and we explained the need for one. My reg and I then went ahead and place a new nasogastric tube. The pain was under control as the patient was hooked up to a PCA. Following the review by our consultant it was explained that surgery is most likely necessary and that we would need to have another CT TAP (Thorax Abdomen and Pelvis) so we know whats going on before we go in.

Open vs Lap surgery was discussed. Usually means that we try laparoscopic first and if we get stuck or any problems occur we need to do a midline incision.

That procedure went ahead as I was just leaving the hospital earlier. More of that in the next day or so.

Two patients had to be brought back to our surgical triage ward – both for drain review +/- removal.

The first one was one of our patients we discharged last week and we ask for the patient to return and if the drain output is non-existent – we can take the drain out. That was for us to do.

The other patient was slightly more complex as this patient has had surgery in our tertiary centre and as the patient lives close by it was agreed to do the follow up in our hospital.

The fact this patient in on the cancer pathway is important as this means I usually do not get involved. However, the skill mix within our cancer team is not great at the moment (and hasn’t been for a while) which means I do get involved and have to take drains out for them and potentially request follow up scan.

This alone seems crazy to have a service which can’t do some of the jobs required for the service they are providing.

I am probably just annoyed as their short coming landing on my desk and causing me additional work.

So, when the emails arrived this patient to have the drain removed, I suggested for the surgical triage practitioners to take the drain out as this is CLEARLY in their job plan.

So, the patient rocked up this morning for the drain removal and I get paged to take the drain out.

My consultant was very good reading the room and said let’s go and review the patient during which I removed the drain.

But this isn’t the first time this happened and sure a surgical practitioner can take an abdominal drain out. If not – then in fairness that person is in the wrong job.

So, yes, I need more sleep to deal with some departmental politics, sick patients and needy medical team (kidding – they are lovely really)