Oh boy....

I've nearly finished my first week at work and am really looking forward to the weekend. Work has been fun, interesting, sometimes scary, sometimes terrifying (well just once and briefly), but mostly exhausting. I guess part of it is starting a new job and so much to learn and think about.

I'm really grateful to all the other faculty in the department who have been very supportive, welcoming and helpful. I wonder sometimes how they cope with a big bunch of brand new rotators every year. We must all look like startled rabbits to begin with. There's certainly a lot to take in in the first week. No matter how much you talk to people about it, nothing quite prepares you for the culture shock of supervising 2 lists at once.

Every day this week I've had 1 general surgical list with the same 1st year anaesthetic resident (who is near the end of the year so is actually pretty good), and 1 gynae or general list with a nurse anaesthetist or 3rd year resident. There's anything from 2 to 6 cases on each list. As an example - yesterday in 1 room I had a parathyroidectomy and 2 colectomies, in the other room a live kidney transplant (recipient) and 2 AV fistulae. Today in 1 room I did 3 thyroidectomies, and in the other room a mixture of CEPOD type stuff. Tomorrow I've got another 3 thyroidectomies in one room and 6 hysteroscopies in the other room. By the end of the week I'll have done about 30 cases.

Sometimes I feel like I'm continuously running from the pre-op holding bay to one theatre then the next theatre, then reviewing the next patients, then it's time to wake one room, then start again.... It's quite intense and hard work at times. I counted my pager went off 25 times today. It's nice though when the last patient is on the table and I can retire to the office, supervise the monitors from my computer and check my e-mail. I probably hang around longer in theatre than I need to, but at present it feels very strange to just walk out. I try to stay till at least knife to skin, but it's impossible in the morning when there are 2 cases to start at 07:30.

I try to fit in some teaching where possible, but so far I haven't had as much time as I'd like. I'm sure though that as I get more used to the system I'll get more efficient and be a bit more productive. I'm supposed to teach the residents on at least one subject every day. I had to make my excuses for a quick exit though when one of the third year residents asked me to teach him about renal pathology. I brought out my A-Z of anaesthetics textbook for such occassions so that I can have a quick revision at lunch time...

I've had a couple of moderately difficult airways so far and some challenging cases by my standards (but I've been told they're all normal for Michigan). My highest BMI so far was 52. One of the other rotators has already had a patient with a BMI of 60. We're probably going to have a prize for the biggest of the year.

Supervising the nurse anaesthetists is strange. It feels very unnatural to supervise someone who has been giving anaesthetics for a lot longer than I have (like since I was in primary school!) Especially when they do things in a way that I wouldn't. I've found so far that I can suggest things - and it's OK as long as they were planning to do it anyway, but not if they weren't planning to do it. My experiences with them have ranged from very positive to the absolutely terrifying. But that's a story for another day....

The hours have been good so far. It's early starts, but I've been relieved and sent home at 15:30 on 3 days so far, and on the other day I was meant to be there late, but I actually got sent home at 17:00. Having kids, this is a huge bonus. I get to spend some quality time with them before bed time. I'm usually in bed not long after them though.

Life out of work is good, and it's like we're on a holiday because there's so much to explore. We have an awesome car, the house is feeling like home now we have some photos up, the weather has been great - it was 27 degrees centigrade yesterday (although weirdly there is a chance of snow tonight). There was a great thunderstorm the other morning when I was cycling to work.

Sorry I let you down on the photos, but the camera battery was flat. Am working on it. Next time for sure...

Take care all,
Thanks for reading,

Drake.