Emergency work I think is one of the hardest, if not THE hardest discipline to follow in this profession. That’s because not only do you have to be quick getting to a diagnosis (sometimes making intuitive or logical leaps in lieu of test results) and the fact it touches on virtually every other discipline (making it the ultimate in general practice), but because it demands a lot of you physically and mentally.
There are two main work patterns I’ve seen: one is the week-on week-off rota, which is somewhat rigid but is predictable and regular; the other is the more flexible but less predictable (and not regular) three-on-four-off, and variants thereof.
I work the first type and think it is a massive fortnight-long endurance test.
Working a week of about 105 hours long, usually with no breaks, is an exercise in either self-challenging or masochism. The shifts are 14 hours long and you have to sleep through the day, which is difficult in itself, often getting only three or four hours sleep – and that’s on a good day where the rest of the world plays ball. Don’t forget the postman (who often rings more than twice, bless him, because he knows me and can see the car outside) and neighbours with building work.
For a week at a time you are effectively out of contact with most of the world because you need to sleep, and need to guard it jealously.
The main advantages to this pattern are the regularity (allowing you to build up a rhythm and a routine) and the fact it gets easier to sleep in the day as the week goes on. The disadvantages are social exclusion for half the year, and the tremendous effect it can have on you – anyone trying to hold a conversation with me if they catch me between work and bed will know I either have trouble finding the next word or waffle on stupidly.
Even on the recovery week I jealously guard Mondays and Tuesdays as “wake up time”. These are my days I have to myself, to sleep whenever I need it, buy milk, and catch up on e-mails, essays, and so on. I am also either going cold turkey or at least reducing coffee consumption on these day – I drink so much coffee of different types that I can now taste the difference between different brands and even nationalities, and know different ways of brewing a cup depending on mood and time available.
Very little useful gets done around the house until I’ve stopped finding myself just staring at the wall for 10 minutes at a time. These are good days to catch up on TV recorded on the Sky box. I worry people think I’m being lazy on these days, but then I have to remind myself that a 105-hour working week is not lazy.
It is a curious situation, though. Even after seven nights, I can still think quite clearly and get the situation sorted when a case comes in. Adrenaline can be your friend.
I am now in the habit of working drug dosages out in two different ways each time – and that is part of what I think helps people cope with the strain of this: a realisation that you and your mind are compromised by the “altered sleep pattern” (lack of sleep, exhaustion, call it what you will) and working around the effects where possible.
The shift pattern affects you and the way you think. My memory is a shadow of its former self, and I am more absent-minded than I used to be, but work around it using paper “to do” lists and keeping notes. I am grumpy and intolerant of anything and everything until about the Thursday of my recovery week. Nobody, other than someone who works the same patterns, understands the effects it can have.
On the upside the “week off” is a good time to study and catch up on hobbies. I also get to play a bigger part in my children’s lives than when I have worked in day-practice.
Emergency work is also the “specialism” that includes nearly all branches of veterinary medicine, even dermatology. Referral is difficult because the cases you’d most like to refer to a specialist are frequently those that cannot be moved!
Parts of it are arcane (like arterial blood-gas analysis) and yet everyone and their dog likes to tell you how you should do your job – “complaints and queries” from colleagues seeing cases after me far outnumber those from clients, but are usually just differences of opinion or approach when you get down to it.
Every so often you need to put references in there to support what you did or didn’t do. I had one colleague try to tell me I should have used a reference she found for a toxic dose of a toxin from Google over the different advice from the Veterinary Poisons Information Service. How do you respond to that…?
I do love emergency work. It’s demanding in lots of ways, but the compensations are the reward of making patients immediately better, and the satisfaction of closing your eyes on a Monday morning and just deciding to wake up when you wake up!