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My Night on Call…Fight or Flight

Authors: Mr. Mohamed Abouelazayem MBBCh MSc MRCS, @MoAbouelazayem General Surgery, Royal Free London NHS Foundation Trust Academic coordinator of The Upper Gastrointestinal Surgeons (TUGS) community Social Media Lead in the Roux group committee of Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS)

It’s 3 a.m., and I am 6 months into my first registrar job in the UK at a major trauma centre in London. Being a general surgery registrar is difficult, especially at a busy trauma centre. It requires a whole set of new skills: decision-making, prioritisation, and leadership. After sorting out all the jobs remaining from the day team and admitting a few patients, I was about to get some rest when my bleep started screaming again. 

The A&E microphone was calling for help in the resuscitation area with a patient who might need a thoracotomy; how interesting and how lucky I am to work in a place with Cardiothoracic surgeons on call! We went there, driven by curiosity, to watch a thoracotomy. I walked into the cubicle and saw the A & E consultant, whose face I will never forget when he looked at me and said: “This patient is 23 years old, stabbed in the abdomen and is exsanguinating. He needs to go to theatres NOW”. 

I glanced at the monitor, showing systolic blood pressure of 60 and blood on his abdomen with a stab wound about 4 cm long. Red blood bags and lines running through his arms. My adrenaline levels skyrocketed. I called my consultant, woke her up, and told her this patient needs to go to theatres now! She said, “I am on my way.” I can easily say these were the most stressful moments in my career until now. It’s a new place for me, a new culture, a new hospital, and I must do something to save this patient. Looking around, I realised I was the most senior surgeon in the room. My brain and heart were racing; where is the bleeding coming from, what will I do, what do I need to do before scrubbing? I asked the scrub nurse for a knife, big scissors, and tons of packs. Luckily, I did my Definitive Surgical Trauma Skills (DSTS) course with RCSEng 3 weeks ago (a course for ST6 to ST8 level). Fine, I will follow the principles: laparotomy, packing, and wait for my consultant to arrive. I will stand to the patient’s right to pack in a systematic way. But I am left-handed, so I usually stand to the left for better control. It might be the spleen bleeding, so I need to pack systematically, starting from the left upper quadrant. So I decided to use my right hand. I looked at the anaesthetist for one last time, and he said, “you need to start.” 

I managed to enter the abdomen with a full-length midline laparotomy in less than 30 seconds. Diving in a blood pool while sucking out as much as possible, I packed every quadrant and put some pressure on it. I looked up to the anaesthetist, took a deep breath, and asked about the blood pressure. At that moment, my consultant walked in and asked what did you do? It had been about 30 minutes since I called her. The most difficult and stressful but satisfying 30 minutes in my short career. 

We spent about another hour controlling the bleeding from the bowel and closing a hole in the IVC. The feeling I had after leaving theatres was indescribable. The patient left the hospital on his feet 30 days later and paid a donation to our hospital to help surgical trainees attend the DSTS course. At the end of the day, I could proudly say I saved a life today!


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