The week in review

Posted by Dr.Thunder


So, it's been just over a week since I started my new job, and so far so good. The people I work with are friendly, and the hours haven't been too onerous.

I guess my main problem is one that many docs will identify with in a new environment. It's the lack of trust that I sometimes face. I'm reasonably experienced in neonatology, and would regard myself as reasonably good at the job. I'm not perfect, but I can do enough to get by.

So, it's a bit frustrating when I outline a management decision to the nurses, and they just run it by one of the other registrars "just to make sure". Some of these registrars are more junior than me, which makes it doubly frustrating. I'm all for teamwork, and I have to admit spending alot of my time asking 2nd opinions from the other docs, because things are often done very differently here in Oz. But when ever decision you make is questioned, it gets a bit tiresome.

I was in theatre the other day for a "high risk" delivery. We go to these deliveries to resucitate the baby if the need arises. Usually ourselves and the obstetricians co-exist peacefully. But today's on-call obstetrician doesn't like new faces. I walked into theatre and started preparing the resus equipment for the impending caesarian section. He walked right up to me and, without introducing himself, said "I don't want a resident here. I want a registar for this delivery". I told him that I was the registrar, to which he replied "I said I don't want a resident, I want a reg".

Indeed.

After I convinced him to let me stay he said "You know this baby is going to the nursery with you, don't you?".

"Well, let's see how the kiddy is. It might be fine, in which case we'll just leave him or her with mum".

This sparked a big argument. He was adamant that this baby should be admitted for observation, regardless of it's condition. I said I wasn't admitting a well baby. He said "Look, I know you're only new here, and you don't know how we do things. But this baby is getting admitted to the noeonatal unit".

I agreed, just so he would hurry up and get this baby out of it's bleeding mother. So, a few minutes later, one completely well baby came into this world. I gave him back to his mum and tried to escape back to NICU, as the obstetrician sutured a uterus, or whatever it is they do.

But I was too slow for his eagle eye. He noticed, without even looking up from the ovaries in front of him, that this deviant paediatrician was trying to leave babyless. The argument flared up again. As far as I was concerned, he doesn't have admitting rights to scarce neonatal beds.

I wasn't trying to be unhepful. I probably admit more babies for observation than I need to. But I'm really very strongly againt the idea of splitting up a mother and her baby straight after a traumatic delivery.

I told him he could call me if the baby showed any signs of being ill. Nope. Not good enough. "I want a consultant opinion", he said. Ok.

"Hi, neonatal consultant on-call. It's Dr. Thunder, your new registrar. I've just been at an emergency c-section for a maternal bleed. They were worried about the baby in utero, but he's totally fine. No resus required. I've given him back to his mum. But Dr Obstetrics wants to observe him in NICU. I've told him it's not neccesary, but he wants a consultant decision".

This is where the 2nd tier of distrust comes into play...

"He can't possibly want an admission for that reason. You must be missing another issue".

Oh sweet jesus.

"No, I'm not. I clarified this with him. The one and only issue is the maternal bleed".

"OK, don't admit the kid. It's not neccesary.....you need to be careful about over admitting. Dr. Thunder. You don't want to seperate mum and baby early on unless you have to. That's not how we do things here".

I NEVER WANTED TO ADMIT THE BABY. I WISH I'D NEVER SEEN THE BABY!!!!!!

So, i went back and explained the situation to a disgruntled obstetrician, who mumbled something about crap neonatal care.

I was glad to get back to the neonatal unit. Back to familiar territory, where I could make decisions about head circumferences, neonatal lung disease and such other familar topics, without a fully formed uterus in sight. Even if those decisions do get run by my more junior colleagues "Just in case".