Monday 5 December 2016

A day in the life

Woke up, fell out of bed, dragged a comb across my head. 

Don't worry, this isn't a post about music, though that would admittedly be a pretty freaking awesome thing to write about.  Ever since my recent push into politics I've thought about expanding the scope of this blog beyond just medicine, but whenever that stupid thought stupidly flits across my stupid brain, I realise that I don't have much else to say.  And that's rather sad.  Regardless, this post is not about the Beatle's song "A Day in the Life", it's about a day in my life. 

Several people have asked me what a typical day is like in the life of a trauma surgeon.  What I go through, the kinds of patients I see, what I actually do from minute to minute, etc etc etc.  So here, ladies and gentlemen, is my well-thought-out, eloquent, and completely unexpected answer:

There is no such thing as a typical day.  


Ha!  That sure was easy!  Time for a beer.

What?  What do you mean that isn't good enough?  You mean you want more?  You want actual details?   You do realise that when I typically go into details many people run the opposite way screaming.  You're sure?

FINE.  You're awfully demanding, did you know that?

Let's see, where to begin.  Well, I'll omit the part where I wake up, usher my little monsters out of bed, try to corral them into the kitchen to get them to eat something that resembles a healthy breakfast, help Mrs. Bastard prepare their lunches, and try to find time for my morning cappuccino.  Mmmmmmmm . . . cappuccino . . .

That reminds me, I've only had one coffee today, and today is most definitely a two coffee morning.  I won't bore you with those details either.

Wait, where was I?  Oh, right.  I was trying not to bore you with details of my morning and failing miserably.  Alright then, back to business.  I'll do my best to describe a call day I had recently, which was typically typical for a typical call day.  These are the actual approximate times in my day, starting with . . . 
  • 7:58 AM Arrival at hospital.  Fuck you traffic, I'm two minutes early!  Ha!  Plenty of time for another coffee.
  • 7:59 AM (yes seriously) My pager alerts me to my first car accident of the day, fortunately not my own as I hadn't even gotten out of my car yet and nearly spilled my first coffee of the day which Mrs. Bastard had very kindly put in a to-go cup for me.
  • 9:00 AM My second car accident of the day.  Still working on reading Car Accident #1's CT scans.
  • 10:05 AM Discharge Car Accident #1, working on fixing lacerations on Car Accident #2.
  • 10:30 AM Discharge Car Accident #2.  Breathe.
  • 12:05 PM Lunch. Chicken, rice, broccoli. Hate myself for eating healthfully and look for a doughnut.  Fail.  Eat more broccoli instead.  Damn it.
  • 1:38 PM Car Accident #3.  So far. 
  • 2:10 PM Car Accident #4.  Car Accident #3 is still getting X-rays done.
  • 3:00 PM Wait for radiologist to read films, catch up on dictations.
  • 3:55 PM Level 1 car accident (#5).  She is morbidly obese, approximately 200 kg, sustains massive internal injuries.
  • 4:45 PM Pronounce Car Accident #5 dead.  Discharge Car Accident #3, admit Car Accident #4 for his fractured femur.
  • 5:04 PM Car Accident #6.  
  • 5:04:05 PM Curse Call Gods for making this a Shitty Car Accident Day.
  • 6:30 PM Stuff dinner into my mouth, if you consider cold leftover chicken and more fucking broccoli to be dinner.
  • 7:05 PM Admit Car Accident #6 for multiple rib fractures
  • 8:11 PM Car Accident #7.  Goddammit.
  • 9:05 PM Catch up on dictations.
  • 11:15 PM Lie down to try to sleep.  Fail.
  • 12:54 AM Level 1 fall.  Turns out to be an extremely drunk asshole who fell while trying and failing to fight gravity.
  • 3:05 AM Level 1 stabbing victim, stabbed in the head.  Active bleeding from the scalp.  Place suture to stop bleeding, order CT scan.
  • 3:21 AM Level 1 stabbing victim #2, stabbed in the abdomen.  Examine his abdomen (which is benign) while the first stabbing victim gets his brain scanned (no brain injury, just a scalp haematoma).
  • 3:25 AM Level 1 stabbing victim #3, stabbed in the chest.  Put in a chest tube, drain 500 ml of blood from his left chest.  Order chest X-ray.
  • 3:26 AM Level 1 stabbing victim #4 (yes, really).  Stabbed in the chest, arm, and leg.  Doesn't seem to be dying.  Order chest X-ray.
  • 3:50 AM Check on first three stabbing victims.  None of them appears to be dying.  Look at X-rays.
  • 4:35 AM Finish viewing X-rays and CT scans on all 4 stabbing victims, find no other serious injuries.
  • 4:39 AM Admit Stabbing Victim #3.
  • 4:50 AM Begin repairing Stabbing Victim #1, 2, and 4's lacerations.
  • 5:55 AM Finish discharge Stabbing Victim #1, #2, and #4 home.
  • 5:56 AM Breathe
  • 5:57 AM Run (slooooooooooooooooooowly) to call room
  • 5:58 AM Lie down
  • 5:59 AM Realise I still have a shitload to do
  • 6:00 AM Get up
  • 6:02 AM Walk down to lounge to get a coffee
  • 6:04 AM Coffee #1
  • 6:10 AM Catch up on dictations
  • 7:00 AM Coffee #2
  • 7:15 AM Make rounds
  • 8:00 AM Fuck this place.
So there you have it.  There have been no exaggerations here, and believe it or not this doesn't remotely approach the busiest call day I've ever had.  The number of patients this day (14) was just slightly above average, though the acuity (6/14 were level 1) was higher than normal.

So now you can stop asking.  And if you've never thought to ask, now you never have to.  You're welcome, I think.


  1. 24 hour shifts? That can't be in the best interest of the patient that for sure. Hope you get at least 48 off now.

  2. Looks like all the stabbings come in the wee hours of morning. Do you always work 24 hour shifts? I shouldn't complain with my 8 hour shifts.

    1. To answer this and Angelo's question, yes. 24 hour shifts. It is less than ideal, but finding enough trauma surgeons to staff a trauma department 24 hours a day on 12 hour shifts is nigh on impossible.

    2. keeping in mind that many emergency services providers operating in an on-call capacity run 24 on/48 off shifts.
      it is also a different character of work than a regular 8 hour shift job. a regular job is based on being busy for all 8 hours. emergency services is based on getting done what needs to be done and resting when you have the chance.

  3. Can't people just not stab other people? That would make things much easier.

    1. But then I'd have a lot fewer stories to tell. Is that what you really want?

  4. You forgot to add "go onto Twitter to destroy sone more antivaxxers, homeopaths and detoxers"

    1. Lets just shorten that to "nutcases"

    2. Not necessarily nutcases, no. It can be hard for the common people to go through all the information they get assaulted with and figure out what is true and what isn't. A Facebook friend of mine is quite fond of "anti-media" "news" outlets. You could show him evidence that what he thinks is wrong and he wouldn't believe anything you say because he doubts all that is done by legitimate sources. People are scared and misinformed because assholes think it's funny to plant the seed of doubt in their mind. While I truly can't find the humour in it all, I can admit that is it much easier to make people doubt legitimate sources than it is to make them believe it. You make people believe that all research is funded by the rich elite or "big pharma" or the like and that that means it's biased and logic has already lost.

  5. so if my math is correct, that is a total of 12 in 24 hours.

    obviously you're in a bit bigger town than I am. (well, besides the obvious fact that we airmail any patients who need a trauma bay to a bigger town) because 12 calls in a day is a busy day for us - and most patients don't go to trauma.

  6. I really enjoy reading your medical adventures. You always confirm my decision 35 years ago not to attend medical school was the right decision for me. Sure glad this was the right path for you. Please keep the stories coming.

  7. Car accidents and stabbings (sigh)... What a day! Don't you wish you could have had "Middle-aged woman hurled onto head off 6-foot-at-shoulder klutzy horse who tripped at canter" for your list? My one experience of the trauma world, which, oddly, was the quietest place in the hospital that Friday PM. (Thanks to helmet, no major harm done.)

    1. Oh I've had them too. And several people kicked by a horse.

    2. That's one asshole horse!

      Great post as ever Doc' - I just hope that isn't really typical. That has to be a busy day even if it's not approaching the busiest ever.

      What I don't understand is why it makes a difference whether you have a 24-hour shift every three days or a 12-hour shift every day and a half. For example, if you do 24-hours on, 48-hours off then you need 3 surgeons in total. If you work 12-hours on and then take 24-hours off you still need 3 surgeons. I'm sure I'm over-simplifying this somehow but I don't see the difference, save that the surgeons aren't dog-tired at the end of a 24-hour shift.

    3. to show you why 12 on / 24 off isn't all that good. I worked a rush construction job that had us on 12 on / 8 off, 6 days a week for a month. by the third shift our frame of reference for time of day was whether there were waffles in the cafeteria line. by the fifth shift, the boss' daughter was starting to look attractive, and during the 7th shift, basic safety rules were not connecting. in comaprison, I worked another project that was 12 hours a day, 7 days a week. we were safer and more productive, despite having the same number of work hours in the week, and a significant part of that was that we were still able to be awake at the same time of day (my shift was 7PM-7AM) every day, instead of having to reset our body clocks every shift. my normal duty cycle is on call from 8:00 saturday morning to 5:00 friday night, and on duty overnight on Friday. (as I said above, 12 of ANY call in a day is a busy day, and we don't all respond to every call. the majority of our firefighters average less than a call a day)

    4. Ugi - Running a trauma center on 12-hour shifts generally would require one of two things: either 3 surgeons for the day shift and 1 who is willing to work nights (or have the 4 rotate night duty), or have 6 surgeons, 3 for day shifts and 3 for night. 24 hour shifts are not ideal, but it beats the alternatives.

  8. The prevalence of suicidal thoughts among surgeons 45 years or older is 1.5 to 3.0 times more common than in the US general population. Six percent of medical students quit med school and go into other fields. Twenty four percent of surgeons end up getting divorced. Nope. It's not for me. Education and training would probably a cake walk for me but that's not the kind of life I'm looking for.

  9. Doc, I'd like to know if you had any suicidal thoughts being a surgeon.

  10. I find this one very disturbing. 15 percent of surgeons haven't had sex in years!

    1. which means 15% of surgeons have at least one point of commonality with the average internet troll.

  11. to give a new perspective. there was a story in our national news about a neursurgeon in Florida who was the only neurosurgeon in his =hospital.

    they even had an interview with him.

    interviewer: "so..."
    Call Gods: "BEEP BEEP BEEP BEEP"
    surgeon: "sorry, I have to go."


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