Monday-Friday (weekends depend)
A typical Monday morning for me begins on the ward rounds.
My team has been on call over the weekend and we must see each new patient and work out whether they’re all on the correct treatment, whether any tweaks to their medication might be needed or whether we need to speak to other specialists to get involved.
One elderly patient collapsed whilst out walking and ended up on our unit. He underwent stenting (see below) of his coronary arteries yesterday but it is clear that this was not very beneficial.
Examining him, it is clear there is nothing more that can be done for him. He had a fairly severe heart attack, and a large part of his heart muscle has died.
If he were younger he may be a candidate for surgery but I do not think the surgeons will be particularly keen to get involved here.
He will, nevertheless be discussed at our afternoon multidisciplinary meeting, where cardiologists and cardiothoracic surgeons discuss patients together to decide on the most appropriate management plan. In his case I feel this is a simply a formality, but we shall see.
One other patient has arrived this morning with an arrhythmia. He hd been feeling faint intermittently for a number of months, but this time he collapsed and had to be brought in.
Following my initial assessment it is clear that he will require a permanent pacemaker to prevent such attacks in future. This will be done in the next few days whilst he is still an inpatient.
I need to call my colleagues to see whether anyone has the space to fit him onto their list.
Lunch is unfortunately eaten alongside my secretary who insists I need to go through some urgent paperwork with her.
She shows me emails from patients demanding to have their clinic dates changed and their angioplasty brought forward. We are running to capacity and I need to decide what can possibly be done to keep everyone happy.
Of course this is hardly ever possible. I manage to sort out a plan that means I will have to work faster during one overbooked clinic next week, and my secretary will have a horrible afternoon re-organising everything for next week’s cardiac catheterisation list. What a great result.
The afternoon is spent in a cardiac catheterisation laboratory. I have two afternoons here a week, and I feel it is the most interesting part of my job.
I perform a variety of procedures, from angioplasty and stenting of narrowed coronary arteries, to pacemaker insertion and simple investigations.
The most difficult case of the afternoon turns out to be a simple angioplasty or stent insertion for a gentleman that turned out to have much more severe disease than previously appreciated. One of the arteries is completely blocked and after multiple attempts using some fairly sophisticated techniques we manage to get enough of a channel opened to get some flow across the artery. Only time will determine whether this will result in better function for this patients heart but we’ve certainly tried our best.
This long case means we must cancel our last patient as we’ve run out of time. We need to re-assign a date and time to her before she goes home. This simply adds to the pressure on our schedule for the next few weeks.
I must apologise to the patient we’ve cancelled and she is actually very understanding. Most patients are.
I must now head back to my office to catch up on emails that have been neglected.
Of the issues I must deal with the most pressing is a medical student that appears to be failing her cardiology module. The medical school would like me to see whether I can offer her any extra clinics.
Other problems are mainly concerning our pharmacy department trying to dictate which cardiac drugs it should stock without fully consulting all of the consultants.
As with most NHS problems, I’m sure cost is at the bottom of all of this, but we must at least have a consensus that ensures everyone has feels they been involved.
It’s a late finish, like most days. Cardiology is a busy speciality with increased out of hours commitments over recent years. However the job is still rewarding and fascinating and one that I would recommend to junior colleagues that show an interest.