By the time you’ll be reading this, I’ll be officially done with the 3rd of 4 compulsory postings in my housemanship year: Surgery.
As you’ll know if you’ve followed my housejob journey so far, I completed my first two postings, pediatrics and obs/gyne at the State Specialist Hospital, Ikare-Akoko. I then made a switch to State Specialist Hospital, Akure (now University of Medical Sciences Teaching Hospital Complex, Akure) to complete the rest of the housejob year. Both hospitals are in Ondo State, Nigeria.
On resuming at my new work place, I initially thought that I’d start with Medicine posting and Surgery will be my last, but that was not to be. I was posted to the department of surgery to resume.
Surgery is a sub-speciality in the practice of Medicine that deals with the management of diseases and disorders by operations involving incisional or manipulative measures. However, certain cases can be managed conservatively (without having a surgery done).
We were 10 houseofficers in Surgery alone, this was more than all the houseofficers in my former workplace and I was like wow! To those who work in relatively bigger centers with about 30 or more HOs per department and close to 200 houseofficers or more in the entire hospital, this number might seem very very small. The truth is, it’s actually small and (as with most public hospitals in Nigeria) more doctors are needed, but we somehow manage with this number, which fell to 7 by the time I was leaving.
The first few days were really chilled. I wasn’t immediately assigned to any unit so I basically moved across different units, getting a feel of the place. There are currently 5 units in the surgical department of the hospital: General Surgery, Pediatric surgery, Plastics, Urology and Orthopedic surgery. Throughout my posting, I rotated through the different units in that order, spending about 2-3 weeks in each unit.
The posting for me was a breeze, considering where I was coming from. The general daily routine was pretty basic. We had morning reviews daily where newly admitted patient cases were discussed with the consultants and medical officers/residents in attendance. The doctors on call overnight present the cases of admitted patients and the presentation is critiqued, from the history taking to investigations and diagnosis and lapses are pointed out and addressed. The point of the reviews is to improve patient care and prevention of repetition of any identified errors in future patients hence improving management.
I particularly liked the morning reviews (except when I was the one presenting, I hated it then) because, although you get questioned and all that, it was an opportunity to learn and get better at management. My only issue was the fact that we usually identified some systemic problems for which complaints have been made severally without seeing any significant improvements which is actually really annoying. Some issues are raised and everyone already know that it wouldn’t be solved because there are so many things involved.
On some days, houseofficers got to present a topic after the morning review. This was also another learning opportunity. I somehow ended up having to do two presentations when everyone else did just one and I was just wondering, why me? But I did it anyways.
After this presentation, everyone splits up; on days that there’s no presentation, the splitting happens immediately after the morning review. The houseofficers to be in the clinic for the day go there, while those for ward rounds go there. On unit surgery days, the houseofficers in the unit go to the operating theater to assist or do any other activity required of them. Usually whatever activity you get split into for the day is where you stay for the rest of the work day, except something happens somewhere and extra hands are needed.
After finishing your ward work/clinic/surgery, you are basically done for the day but you still have to be around the hospital till 4, just in case you’re still needed. If you are on call for the day, your call work starts from 4pm (after working 8am to 4pm same day) and you have to see patients, ensure their investigations and some other stuff. You also get called if there’s an emergency. It wasn’t always this simple but this is the basic gist of it all.
In this hospital, your emergency posting is intertwined with your regular postings, you do a 6 – 10 hour shift in the emergency 3 to 4 times a month, along with your departmental calls. This was the most unimpressive part of my surgery posting. It was somewhat similar to what we did at Ikare. I really do not like emergency medicine. I really didn’t look forward to those calls at all. My lack of interest in it made me not enjoy it as I should. This lack almost put me in trouble which I wrote about here. The experience taught me that as doctors, we really cannot work without enthusiasm. You have to give your all or not at all. I learnt from it sha and I definitely will do better moving forward.
While drafting this post weeks back, I had written that I haven’t had to certify any patient dead all through my posting, no patient had died while I was the one on call – not because of me or my skills or anything, it was just something I noticed. It so happened that on my last call in surgery, one of our patients on the ward died. I didn’t really expect it, although the senior doctor on call with me had said his condition was bad. He was in the hospital for roughly 24 hours and so we were managing based on a provisional diagnosis while waiting for investigation results to confirm it. An autopsy couldn’t be done to identify the exact cause of death.
It was also the first time I was having a surgery while on call. It was an appendectomy and I was the assistant surgeon. While assisting, I was considering if I could actually become a surgeon but I really don’t see that happening. Surgery was once my primary choice for residency, primarily because it was seen as a ‘man’s job’ and I wanted to prove people wrong. I have since realized that that shouldn’t be the reason for choosing a career path. Rather than trying to prove people wrong, just do what makes you happy, even if it’s not the most popular thing out there.
This posting legit seemed longer than 12 weeks to me and although it wasn’t particularly stressful, I’m glad it’s over now because that means I’m one step closer to finishing this internship year. At this moment, I’m more anxious than excited about finishing this phase (the level of anxiety ebbs and flows), but I know that one phase has to end to usher in another. I also know that whatever comes, no matter how it looks, I’ll be alright.
By the time you’ll be reading this, I would have started the 4th and final posting in this housemanship year – Internal Medicine. I’ve heard quite a bit about it and I am just glad that it’s the last in this phase.
I’m happy that I get to write about my housemanship year and will be able to look back in years to come and see a piece of me from these times. This is one of the major reasons why I write.
Till next time,
Sisikunmi.
