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Reflexión de Oscar Iglesias «El cambio climático no es UN cuento»

Sinceramente es estúpido, siento ser tan agresivo en esto, es de ser estúpido negar la evidencia de que existe un cambio climático y un calentamiento global, los fenómenos climáticos extraordinarios, al menos extraordinarios hace 30 o 40 años son ahora la nueva normalidad, el verano en mi país que es España ha empezado muy fuerte, estamos viviendo una ola de calor con nuevos records de temperatura para finales de Junio y principios de Julio, una ola de calor que según tengo información está afectando a gran parte de Europa, cada año hace mas calor y las olas de calor son mas largas e insoportables, yo ahora siempre estoy diciendo que Madrid parece Bagdad o Marrakech, este calor en Madrid no lo tenían ni en Sevilla en los 90, este calor no debería ser normal pero por desgracia estamos viendo que esto es la nueva normalidad.

Algunos me dirán que las climas cambian de forma natural, es cierto y si no hubiera tanta contaminación para que se me entienda, las temperaturas probablemente no subirían tanto, esto y además probado, es culpa de la acción del ser humano, demostrado por prácticamente todos los científicos estudiosos en este tema.

Y esto lamentablemte irá a peor, mientras tengamos a sujetos como Mr. Danger II, Donald Trump, un negacionista, estupido diría yo, convencido, pues el futuro será complicado.

¿Qué opinais? Dejarme vuestro comentario libremente, como sabéis agradezco de corazón vuestros comentarios y darle a me gusta si os ha gustado, si no, pues no lo deis jaja, un abrazo grande.

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My First Day In General Surgery – Tagging Day 1

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My “Day 1 of life” in the Surgical Department commenced on the 4th of July 2024 which fell on a Thursday.

I was allocated to work in the side room of Female Surgical Ward (FSW) with a fellow colleague whom I’ve worked previously in the night shift in Paediatrics.

I left home around 5.45am and arrived at almost 6am and started reviewing as usual. I took some time as I read through the previous entries and used it as a guide to write my morning reviews.

Upon reviewing around 4 patients, a fellow medical officer arrived and automatically, I greeted him and followed him. It has become a reflex of mine as in other postings, we had to be like that, which is a good practice.

He was friendly and had a kind demeanour. Thus, I followed him, not knowing that he is actually the medical officer in charge of the HPB (Hepatobiliary) patients.

Usually, there will be a house officer in the ward in charge of the HPB patients, which I did not know of course, considering that it is my first day. Thankfully, I had a partner who followed the “GS – General Surgery” rounds with the other medical officer instead.

As usual, rounds with medical officers followed by rounds with specialists in the morning and as House Officers, we are their assistant and scribe. The morning rounds ended and we proceeded with tracing the joblists for each patients in our allocated cubicles and updating it in the “MOHO” group as well as proceeded to complete the active job-lists.

This is then followed by afternoon reviews, afternoon rounds with medical officers and specialists followed by the completion of the active joblists and finally starting with on-call reviews and preparing our handover lists.

Considering that I am still tagging, I had to stay till at least 10pm. After completion of the on-call reviews, we followed the on-call rounds and HPB (oncall rounds), clerked and transferred in the new patients, completion of the active joblists before finally heading home.

Overall, my first day in Surgery was surprisingly good and calm. The medical officers and specialists seemed rather kind and patient. Thus, giving me the encouragement to continue despite having heard that this particular posting seemed like a rather toxic one which only serve to instil fear in me prior to joining this department.

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I Ordered A Chest X-Ray For The Wrong Patient | Housemanship Diaries

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It was during my tagging period in the Surgical Posting and I was a Female Surgical Ward.

It was my first day being in charge of the acute beds and side room. I recalled one of the patients being a Urology patient. Usually, if the patient is from other departments, we are not required to review them. This patient in particular was intubated and sent to our ward to be placed in one of the acute beds for further monitoring from the Urology ward.

Upon transfer into the ward, the patient required a portable CXR for post-intubation. I did not screen through the casenote since it was from another team. The nurse in charge informed me of a new case but did not tell that the patient needed a CXR. Hence, my reply was “it’s not our patient, it is from a different team. They will review later.”

Hence, the Urology Medical Officer on call came after a while and reviewed the patient. He went to check the system and was confused as to why the chest x-ray was not done for the patient. The nurse immediately informed that I did not want to do it considering the patient is from another team.

At that time, afternoon rounds with the Surgeon was currently ongoing and I was disturbed from writing my reviews. I immediately proceeded to fill the form and had it sent to the Radiology Department to request for a portable chest x-ray.

Amidst the rush, I had wrongly written for another patient instead.

I only realised it when the radiographer came and did an x-ray on two patients at the acute beds. One, the intubated patient from another department and another which is a patient of ours.

I realised my mistake and rushed back to check the form and was met with a very angry daughter of the patient.

I admitted my mistake and was yelled at. After such a tiring week and a hectic day on top of tagging itself, I could not contain myself any longer and tears started streaming down my eyes uncontrollably.

Thankfully enough, it was just a mere chest x-ray and nothing more or a wrong operation done. Since the patient is under the colorectal team, the surgeon in charge and the medical officers in charge will proceed with their rounds again and I could not contain myself again and tears started to stream down my face again.

The medical officer in charge noticed and asked me to go to toilet, understanding that I needed some time for myself to recollect myself again. Hence, I excused myself.

After a while, I went out and rejoined the rounds and admitted my mistake to the medical officer in charge to which she laughed and said “well she has a free x-ray now and were there any changes as compared to the previous one?” To which I answered none.

She was amused considering that it was over a mere x-ray which was requested for the wrong patient that I started breaking down.

Thankfully, it was just an x-ray.

The lesson learnt here was for me to be extra careful in the future because it could have been worse and become medicolegal.

Please try to avoid doing anything out of rush or pressure and always slow down for a bit and reconfirm the patient and procedures to avoid or minimise errors.

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My First Surgical ETD / ED Night Shift Experience

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My first ETD “on-night” or night shift in Surgical was with a fellow junior who I considered as my senior in the posting as she was in the department much longer that I was.

Prior to joining the Surgical Posting, I have went through the Orthopaedic Posting as my first posting and people said that the ETD shift is similar to that in the Orthopaedic Posting, except that we would be taking the bloods, requesting necessary scans ourselves and posting the case.

Before I went to the emergency department, I stopped by the ward to steal some forms and stock up my “file”. After that, I went downstairs and received handover from the morning team.

During my first “ETD ON” shift, there were two medical officers as the first call. One is a tagging medical officer as she had just joined the department.

The night was rather cold I would say with minimal referrals, probably less than 10.

Every time there is a new case, we would be asked to clerk the patient first. However, usually the medical officer would be there by then and we would see the cases together.

I remembered it being “cool” enough that night that we even had time to have dinner for a while before proceeding to take our coming mornings and even rest for a while somewhere.

In the morning, we requested scans that were rejected the day before and followed rounds with no surgeon to know the latest plans, handed over to the following morning team and returned home on time.

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My First Night Shift In Surgery | Housemanship Diaries

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My first “ON” or “On-night” or night shift in General Surgery was in the Female Surgical Ward with a friend whom I’ve known since around my first posting but have yet to be in the same posting together till our fourth posting in General Surgery.

We were blessed enough to have at least 2 people per ward for the night shift.

Our shift as “on-night” in Surgery began from 7pm and will usually last till all the discharges are done the following morning.

Upon my arrival to the ward, I was informed that one patient in particular had no urine in her CBD (urinary catheter) bag and that she felt like urinating but was unable to void. Considering that she had a urinary catheter in-situ, voiding should not have been an issue.

I attended STAT and assessed her. She had a mass over her abdomen which was hard, non-mobile but had smooth edges, around 15cm by 10cm, a rather large one which I assumed was a tumour, probably pressing onto her urinary bladder as well.

It did not occur to me to check if the patient was previously passing urine, it also did not occur to me to check her intake and output chart. All I could think of at that time was, she felt like voiding, she is in pain, there is no urine flowing into her urine bag.

Thus, I prepped the trolley to reinsert a new CBD. I donned my plastic apron and prepped my materials needed and proceeded to clean the patient’s vagina and reinsert a new urinary catheter in as probably as sterile as I could, bedside.

Upon insertion of the new urinary catheter, there was no urine outflow. Thinking that I may have blocked it or inserted not all the way in, totally abandoning my theoretical principles learnt, I proceeded to reinsert about 3 times and each time was met with no urinary outflow but there were bloodstains from the urethra.

I called my partner for help and he proceeded to help me in informing in the oncall group and referred to Urology medical officer oncall who was rather grumpy.

It was during his referral that I realised that the patient had been anuric (not passing any urine) for sometime now. Clearly, she would not have any urine output and although she felt the need to void, it would not have been an issue considering there is a urinary catheter in-situ.

I had unnecessarily caused trauma and I felt foolish for acting prior performing a thorough examination and understanding her case.

The Urology medical officer came and reinserted a CBD to which she asked us not to remove and to request for an ultrasound the following day for assessment as she suspected that the tumour over her abdomen had infiltrated into her urinary bladder or urinary system.

That was settled but definitely ate up a huge amount of our time because of my mistake.

Subsequently I was rather slow and there were a few post-operative patients and new patients admitted into the ward. Hence, I proceeded to do the needful. By the time I was done, my partner had completed taking the blood for the whole ward and at that time, it was around 3am. I could sense the back-to-back disappointment I have caused him and at that point, I have given up on apologising.

We then proceeded to complete our planned discharges of the patients and by 6am, started tracing the blood results of the patients before retiring into the house officer’s room for a break.

In the morning, as usual as in other postings, we would be “summoned” in the group to take any bloods or to start our discharges.

We returned home around 11am and our post-night shift was followed by an off day.

Personally, I felt that I could’ve done a lot better as I was rather slow that night. However, for a first night shift in Surgical, it was not as bad as it seems.

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