Friday, July 23, 2004
Sitting on the Front Step (As the Sun Goes Down)
It's nearly midnight again, at the end of a long and eventful week. How come I always end up blogging at the midnight hour? Anyway, we had a good evening tonight, with chips and dips on the deck in glorious summer sunshine, and later homemade blueberry crumble for pudding. And then Richard & Emma called round - they were watering the garden for our next-door neighbours while they're away for a bit, and they knocked on our door to see what we've done to the inside of their old house! We ended up sitting on the front step, shooting the breeze as the sun went down over the Rockies - very nice!
I've really started to settle into work at the hospital, and am getting more time to read the recent literature on some big surgical cancer topics and (more importantly) some time to think about what sort of surgery I want to do and what research projects I can get going while I'm here. I've already made some progress this week, making a few new connections in my brain and I've got several topics that I'm reading around and getting quite enthusiastic about. This time element is what's lacking in UK surgery - you're so busy keeping the service running that you don't have time to keep up to date with new developments.
I've done 3 weeks of Radiation Oncology and have one more to do before I do a month's Pathology. I've also started to 'tweak' my rotations a bit, deciding what I want to get out of my time in each specialist area and speaking to the appropriate people to arrange this rather than just 'going where I'm sent'. This approach seems to be paying off, and it's good to have this kind of flexibility and get to see the procedures I really want to see here.
My month in Pathology is slowly taking shape at the moment too, and it looks like I'll be spending 3 weeks at the Foothills and 1 at the Peter Lougheed Hospital. I'll also be involved in writing up a paper of some sort too, so more details on that when I know...
The 'salary issue' hopefully pretty much sorted out at the moment, although I imagine there'll be a few more bumps in the road next week before the money is actually in my hand. It's really a case of the hospital bureaucracy gone mad. It's too detailed (and tedious) to go into in any detail, but suffice it to say that the problem relates to my doing on call in the hospital to provide me with living expenses. I'm registered with the appropriate medical authorities in Canada, but the issue seems to be which 'code' I am registered on. One code allows me to be paid, and the other doesn't and here lies the crux of the matter. My code has been changed this week to allow payment, and I've got an email which confirms they will pay me, so I'll just keep working (and claiming payment) until I'm told otherwise. Even if it's an ongoing problem, I should be able to apply for full Canadian registration in Feb 2005, which will allow me to bill for doing operations, etc. and should provide a nice income boost. My colleague is an ENT surgeon from Zurich who is in the same boat as me, but although the hospital will pay him it seems that they don't want him to work in General Surgery as he is here on an ENT fellowship rather than General Surgical Oncology, as I am. He can't work on-call as an ENT doc, and they won't let him work as a General Surgeon, so at the moment it's a bit of a deadlock and he has no income at all. He's living on his own here in a 2-room basement flat at the moment, and his wife is back home and is pregnant too, so if the money issue isn't resolved soon, he says he'll have to go home again, which would be a shame. Hopefully I'll have some better news next week...
More info on my night on call: I was on-call as the junior resident (like an SHO back home), with a medical student (i.e. JHO) on below me and a senior resident (registrar) and staff surgeon (consultant) on above. The medical students are pretty good, but aren't able to make any decisions or prescribe any drugs, so I have to do all of that. The resident and the staff guy are there to decide who we operate on and to do the operation. Although, as I'm a Fellow, I'm actually senior to the senior resident, so I seem to end up taking the resident through the case while the staff guy observes. Go figure, as they say here...
0800-1100: 3 hour ward round. Bit difficult as I didn't know any of the patients, but I kept a list of 'what needs doing' for later on. Eyes and ears open, gub shut on the first day, I say.
1105 Started to enter 'patient orders' for the first time on the computer system, which is all new to me. These are basically instructions for the nurses on each patient. Do this blood test, give this drug, etc. Might be easier to just talk to the nurses, I say, but 'when in Rome'...
1107 Called away to the ER to see an elderly man with a very sore tummy who is going down the tubes fast. Decide we need to open his tummy up, so make arrangements for this. Also called to assess another patient while I'm in the ER.
1200-1300 Running around the wards, prescribing painkillers, correcting electrolyte results and placating nurses. Bleeped constantly. I can only survive because the nurses tell me what to do, as I'm unfamiliar with basic Canadian ward practice and don't know the trade names of common drugs.
1300-1500 In operating theatre ('the OR', or 'operating room')
1500-1530 called to ward to see patient with low blood pressure. Not too bad.
1530-1545 grab 'lunch' (coffee and a bun)
1545-1700 back to the OR
1700-1900 running around wards and ER again. Bleeped every 4-5 minutes or so.
1900-1920 get to sit down and have some soup and a sandwich for my tea
1920-2200 back to the ER again to assess another patient, plus running up and down to the wards
2200-0700 whole night in on-call room. Phoned about every 1/2 - 1 hour during the night, but nothing serious. Longer call at 0430, but don't have to get up.
So not too bad after all, especially if they end up paying me for the privilege! Apparently there are other nights when you're on-call as a Fellow alone, with no senior resident to help, and these nights can be a bit more intense, but hopefully I'll not be doing any of those for a while.
STOP PRESS.... STOP PRESS... Mum and Dad are coming to visit for 3 weeks - THE DAY AFTER TOMORROW! They always said they were coming to see us soon, but we didn't expect it to be this soon! It'll be great to see them again, and the house is all ready for their arrival - they even have a nice bed! It's going to be a fun 3 weeks, and I've asked to be off-call for the weekends while they're here so we can get out and about a bit while they're here. Maybe I can even talk Dad into posting his first blog from here...
Anyway, nighty night for now...
J
I've really started to settle into work at the hospital, and am getting more time to read the recent literature on some big surgical cancer topics and (more importantly) some time to think about what sort of surgery I want to do and what research projects I can get going while I'm here. I've already made some progress this week, making a few new connections in my brain and I've got several topics that I'm reading around and getting quite enthusiastic about. This time element is what's lacking in UK surgery - you're so busy keeping the service running that you don't have time to keep up to date with new developments.
I've done 3 weeks of Radiation Oncology and have one more to do before I do a month's Pathology. I've also started to 'tweak' my rotations a bit, deciding what I want to get out of my time in each specialist area and speaking to the appropriate people to arrange this rather than just 'going where I'm sent'. This approach seems to be paying off, and it's good to have this kind of flexibility and get to see the procedures I really want to see here.
My month in Pathology is slowly taking shape at the moment too, and it looks like I'll be spending 3 weeks at the Foothills and 1 at the Peter Lougheed Hospital. I'll also be involved in writing up a paper of some sort too, so more details on that when I know...
The 'salary issue' hopefully pretty much sorted out at the moment, although I imagine there'll be a few more bumps in the road next week before the money is actually in my hand. It's really a case of the hospital bureaucracy gone mad. It's too detailed (and tedious) to go into in any detail, but suffice it to say that the problem relates to my doing on call in the hospital to provide me with living expenses. I'm registered with the appropriate medical authorities in Canada, but the issue seems to be which 'code' I am registered on. One code allows me to be paid, and the other doesn't and here lies the crux of the matter. My code has been changed this week to allow payment, and I've got an email which confirms they will pay me, so I'll just keep working (and claiming payment) until I'm told otherwise. Even if it's an ongoing problem, I should be able to apply for full Canadian registration in Feb 2005, which will allow me to bill for doing operations, etc. and should provide a nice income boost. My colleague is an ENT surgeon from Zurich who is in the same boat as me, but although the hospital will pay him it seems that they don't want him to work in General Surgery as he is here on an ENT fellowship rather than General Surgical Oncology, as I am. He can't work on-call as an ENT doc, and they won't let him work as a General Surgeon, so at the moment it's a bit of a deadlock and he has no income at all. He's living on his own here in a 2-room basement flat at the moment, and his wife is back home and is pregnant too, so if the money issue isn't resolved soon, he says he'll have to go home again, which would be a shame. Hopefully I'll have some better news next week...
More info on my night on call: I was on-call as the junior resident (like an SHO back home), with a medical student (i.e. JHO) on below me and a senior resident (registrar) and staff surgeon (consultant) on above. The medical students are pretty good, but aren't able to make any decisions or prescribe any drugs, so I have to do all of that. The resident and the staff guy are there to decide who we operate on and to do the operation. Although, as I'm a Fellow, I'm actually senior to the senior resident, so I seem to end up taking the resident through the case while the staff guy observes. Go figure, as they say here...
0800-1100: 3 hour ward round. Bit difficult as I didn't know any of the patients, but I kept a list of 'what needs doing' for later on. Eyes and ears open, gub shut on the first day, I say.
1105 Started to enter 'patient orders' for the first time on the computer system, which is all new to me. These are basically instructions for the nurses on each patient. Do this blood test, give this drug, etc. Might be easier to just talk to the nurses, I say, but 'when in Rome'...
1107 Called away to the ER to see an elderly man with a very sore tummy who is going down the tubes fast. Decide we need to open his tummy up, so make arrangements for this. Also called to assess another patient while I'm in the ER.
1200-1300 Running around the wards, prescribing painkillers, correcting electrolyte results and placating nurses. Bleeped constantly. I can only survive because the nurses tell me what to do, as I'm unfamiliar with basic Canadian ward practice and don't know the trade names of common drugs.
1300-1500 In operating theatre ('the OR', or 'operating room')
1500-1530 called to ward to see patient with low blood pressure. Not too bad.
1530-1545 grab 'lunch' (coffee and a bun)
1545-1700 back to the OR
1700-1900 running around wards and ER again. Bleeped every 4-5 minutes or so.
1900-1920 get to sit down and have some soup and a sandwich for my tea
1920-2200 back to the ER again to assess another patient, plus running up and down to the wards
2200-0700 whole night in on-call room. Phoned about every 1/2 - 1 hour during the night, but nothing serious. Longer call at 0430, but don't have to get up.
So not too bad after all, especially if they end up paying me for the privilege! Apparently there are other nights when you're on-call as a Fellow alone, with no senior resident to help, and these nights can be a bit more intense, but hopefully I'll not be doing any of those for a while.
STOP PRESS.... STOP PRESS... Mum and Dad are coming to visit for 3 weeks - THE DAY AFTER TOMORROW! They always said they were coming to see us soon, but we didn't expect it to be this soon! It'll be great to see them again, and the house is all ready for their arrival - they even have a nice bed! It's going to be a fun 3 weeks, and I've asked to be off-call for the weekends while they're here so we can get out and about a bit while they're here. Maybe I can even talk Dad into posting his first blog from here...
Anyway, nighty night for now...
J
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