Surgical fatigue

One of the pieces of advice I was given before coming out was that I could be working all the time, day and night, and I would have to watch out for myself. This is starting to prove true - I have had a fantastic, if hard work, few weeks but feel like they are starting to catch up with me now.

The working week is currently set with a full day (0800 to 1600 and sometimes later) operating Monday, Wednesday, Friday. Before the list we do the round (at the moment my ward has about 50 patients) and after we check on the sick patients and any new admissions. Generally there is a medical student or trainee licentiate on call on those days, so we have to check on what they have done and review any ward referrals with them. Tuesday and Thursday are for detailed rounds and OPD. We are supposed to do one OPD day a week each, but there aren't enough to do that at the moment. Emergency operating happens whenever it is needed, but most can wait for a regular theatre list.

At the weekend, one person has to see each ward every day. This weekend it is me and Sidney, last it was two medical students so I went in and saw the critically ill patients and new admissions each day. At night, there is an on call system. Every night there is someone who can do emergency obstetrics (this does not yet include me as I have had no time to learn!) but not always someone who can do emergency surgical operating. When the Prof is here, he expects to come in for every major case anyway. When he is away, Sidney and I informally cover that on top of our rota'd commitments (hence I did a midnight colectomy on Thursday night when not on call).

So, things do seem to pile up in a way that they don't in the UK. Coupled with living in the hospital and rarely getting away (we did have a burger and a swim in Chipata after my round yesterday) I'm starting to notice how fatigued it is possible to be. I suspect those familiar with the "good old days" of medicine in the UK probably experienced it in a much more consistent fashion.

While I'm not at the stage of making mistakes through fatigue yet, I have started to prioritise what I do and how I do it in order to prevent myself getting to that stage. Things that don't need to be done urgently can be left to a ward round or routine list, I'm leaving a lot more dressings to nursing staff (even when persistently asked to do all the basic wound care on the wards) and I'm making sure I get home, have a shower and a sit down before dinner at night.

I think the message is, things are busy, they are enjoyable, but if you work with the same intensity as in the UK you will burn out very quickly!