Wednesday, August 08, 2007

There's a blog blocking me up like a constipated out, it's been a long time. Complete bowel obstruction about to ensue. The problem is, the time is so rapidly approaching for my return to the world of full-time work, that there has been no time to record the changes bearing down on me. From planning the minutiae of my children's after-school care to worrying about only having joke shoes and glasses bent back by a toddler and held together with sellotape. Once fetching in a Pulp or Morrissey sort of way, this look is hardly inspiring in a surgeon. One of my bosses (for someone who works only one measly day, I seem to have acquired a fair number of bosses) commented that my clothes didn't match. There are downsides to female bosses. I didn't want to admit that I'd got dressed in the dark. Anyhow, defence seemed pointless. Another said, "you'll have to lose the hippy look". Oh, for a suit and a tie and be done with it. Haven't we enough to worry about without the whole thing of what goes with what. I shall spend as much of the day in blue pyjamas as possible. It saves on dry cleaning bills, for a start.

I've noticed that colonoscoping has got easier. I mean, at about the pace of watching a child grow. Almost visible, yet not. Only when someone hasn't seen them for a few weeks, then they say, ooh he's taller and I think yes, I thought he was taller. Been detecting it in extra gap at the ankle - note: needs new trousers - and yet can't see it. My improvements are a combination of confidence and practice. Interesting to see that the boss (one of em) doesn't intervene now when I'm stuck. I'm kind of left to it. I don't whizz round them all in 3 minutes, but I do whizz round some in 3 minutes. There are always the ego-deflating (mine) and colon-inflating (theirs) depressingly difficult ones. We had a list of them last week. Possibly the most depressing week I'd had in what is now 2 and a half years of this job. Each and every patient was either poorly prepared (bowels covered in poo - like we all are. What a lowering thought. I shall look at the next mean member of officialdom I meet with my X-ray eyes and see through to his poo-covered gut), or hopelessly difficult or both. And worst of all, we didn't achieve anything. No one was saved. A hiatus at the beginning, at 9, when no one arrived for an hour left us hopelessly late at the end, finally drooping out of there resentfully at 7. At least it rained cheerlessly all day, matching our mood.
This week, though, buoyed by the sun we succeeded. We still finished late, but it somehow felt different. I searched carefully for a polyp to have the satisfaction of finding one, hiding in the very last place I looked. You don't want to find cancers. They are big and scary and life-changing, life-threatening bits of news to see round a bend - an intake of breath, somehow the patient is alerted and looks: what's that? of course they ask. Yet how can you have a serious discussion about what it might be, with someone dosed up on benzodiazepines, in the least equable position at patient can be, at the mercy of your scope? Of course it is always better that it was found now rather than later. But the recriminations begin immediately - why did the GP sit on it, the patient not complain more, the husband not notice something? Finding a polyp is usually without these implications. Just all good. Meant the decision to scope was correct. Potential future cancer can be avoided. And you get all the fun of zapping it. Finding ten polyps, when there are 4 people waiting is not good - too much pressure to be fast. So there it is, the is the tiny rectangle of pleasure that keeps you coming back: despite the wrist ache, the excruciatingly dull paperwork, the possibility always of doing it wrong in many many ways, the satisfaction of buzzing off a little polyp in someone's gut. My old boss said you were of surgical intent if you used to squeeze other people's spots as a teenager. I should have stuck to that.

1 comment:

Beach Bum said...

Interesting blog. I shall have to spend some time here reading archives.

I'm an opera singer, currently in first year medical school.