I love Mondays. Mondays that I have off after a weekend on call, that is. Or even, Mondays when I’m working, but no longer on call, freed from the tyranny of the Bleep.
So the end of my time in intensive care is looming. That’s a good thing in general, I can’t wait to get out of here. But I’m worried I’ve not done enough Procedures. That is, tracheal intubations, central line insertions, chest drains (basically sticking tubes into places where there are orifices, or none). Since my ambition is to become a neurologist who spends most time in academic work, I don’t really need to be as slick as, say someone who wishes to become a consultant in emergency medicine, or an anaesthetist. And if truth be told, though there is a certain satisfaction when the blood/carbon dioxide/pleural fluid etc gushes out of a correctly placed line/tube, I don’t particularly enjoy doing these things. Unfortunately (both for me and for my patients), I still have to get signed off as ‘competent’. What I hate most is the feeling of preying on the (literally) vulnerable in order to clock enough of these things up.
At the start of the ITU shift, all the doctors (we are called ‘fellows’) gather around the patient board and divide up the patients. It can be quite tactical, with whoever is likely to need an arterial line or chest drain being most sought after, and whoever is ‘not for escalation of care’ the least favourite. However, one has to consider one’s relationships with colleagues (don’t want to antagonise them too much), and the fact that most of the patients are really complicated, so it is better for them to have the same doctor, at least for a few days where (the doctors’) shifts allow. Being a mild, accommodating type, I usually get the bum end of the deal. Hence my lack of ‘procedures’. I don’t think it’s all quantity though. I think there is a certain critical point when something becomes an ability (a bit like the moment you can suddenly ride a bike). So I reckon I’m able to intubate now. Anyone, of any size, orally or nasally, whether they have teeth or not (this may sound bizarre, but teeth were a big thing, because I started off doing babies on the neonatal unit). Apart from the officially categorised ‘difficult airways‘. But that’s anaesthetist territory.