Care Of The Surgical Patient, Week 4


My second shift in the SAU! The team looked slightly alarmed when I walked in with the crutches, but I just assured them that once I am on the ward I can make do without. I am every physios nightmare patient.

I enjoy SAU, I like being independent and doing all the clarking, coming up with differentials, doing the bloods and I even steal the obs off the HCA’s. However, today was painfully quiet.

I just sat there on the low table, feeling a bit awkward. I had teaching later on in the day which meant I could escape for a bit, but when there are no patients, there’s not a huge amount you can do.

Lunch arrived, and I hobbled off the ward to grab something before teaching. I wasn’t in the best of moods – pain and nothing to distract me from it. Plus these crutches were doing my head in, getting in the way, slowing me down, making everyone look terrified every time they spot scrubs using them.

I tuned into the second of the case based discussions, which was delayed slightly and was again disrupted by bad signal. I remembered I would be at the “big hospital” in a few weeks, and I know the signal there is extremely poor. I remember being in second year and getting a flurry of notifications every time I passed a good spot.

I sound like a complete grump!

I headed back to the ward after to be met with no patients again. I was deciding if to leave or not as I needed to go and get petrol when they decided to grab some surgical patients from the very busy A&E. I immediately jumped into Med student mode and got to take a very interesting history off someone with jaundice. I came up with my differentials and wrote everything down, and waited again.

and that was it.

Some days in Med school are going to be amazing, others, well others will end with you hobbling out of the hospital after 6 hours only having done one history and one examination.

In the evening, the wilderness society had their ticket release for the weekend trip. These are hugely popular and even though I tried, I didn’t get a ticket. They sold out in under a second – more popular than Glastonbury !!


I was meant to be going in to do the post take ward round today. However, after only clarking one patient the entire day before, it wasn’t going to be useful as I would be touring a load of patients I hadn’t seen before.

It might be being a bit cocky, but as I go through the course, I am learning what sessions are useful and what are not. I like Warwick in the fact that attendance is hardly monitored. They trust us enough to know what works for us and what doesn’t. We are expected to show up for formal teaching, but not the wards.

However, you can tell at finals and OSCE’s who exactly has been in and who hasn’t. I generally do go in, and I am already trying to find other stuff to do in Psych block, but I have learnt to recognize when things aren’t going to be useful. Instead, I stay at home and do book work, so the morning isn’t wasted wandering around a ward round where I have no idea who the patients are.


I was meant to be in for a clinic in the morning, but the consultant never replied as to where or when I had to meet them. So, I used the morning to do some work at home and catch up on the huge laundry pile staring me in the face.

We did have teaching in the afternoon about anaesthetics and pre-op meetings. This was useful as we don’t get taught an awful lot about anaesthetics, but we do get tested on it. We went through what happens in a pre-op meeting, what you have to look for and how to recognize a high risk patient.

We then got set homework… I can’t remember the last time I got set homework. I got set to do post-op confusion, I was in a bad mood (honestly I don’t know what is wrong with me) and managed to find a BEAUTIFUL leaflet from the royal college of anaesthetists on my exact topic – Thank you RCoA !

We had to present them the next day, but I hate PowerPoint with every fibre of my being, so I just made a small round up poster instead.


We had the second half of our peri-op teaching in the morning presenting back our homework and learning about anesthetics and managing post-op complication such as over/under working colostomies and bowel obstruction. I have become very familiar with bowels over this block.

In the afternoon, we had our penultimate SIM session. I got to lead a session where the person was bleeding out from a burst aorta. Lucky for me, I got the only session where the SIM dies at the end.

I wasn’t too affected. I wish I had picked up the source of the bleeding earlier and managed my fluids better, but the scenario was always going to result in the patient death.

I always get the happy cases don’t I? 😀


On the Friday, we had a workshop covering prescribing. This is slowly becoming a bigger part of the curriculum now, as our PSA exam is one we have to sit in our final year.

It was mainly things we had covered before, but we also got taught how to prescribe controlled drugs such as morphine. These are the drugs which are kept in a locked cupboard and are normally the source of all key finding on the wards.

After we had a session on surgical urology which involved some very painful looking pictures, but I actually really enjoyed it and learnt a lot.

We then had another online tutorial (which gave me a chance to get back to grab my tablets from the pharmacy and some lunch) on endocrine, which I hate with a passion. I can never remember what is hyper/hypo thyroid, what is steroid related etc.

I think it’s safe to assume I will never be an endocrinologist. However, it was useful, and I just need to keep at it to make sure I have all stations covered for finals.

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