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Hi guys. Last time we did a, a chat about how to get into anesthetic screening. And some of the feedback we got was because I actually wanted to know what it's like to like what a full day actually looks like when you're in training. And I used to have that question as well. That and I were just talking about how, when I had the training, I would ask the senior trainees like, what is an actual day like in your life? And they'd always start talking about what it was like to do an anesthetic. And I kind of was asking like, how on earth do you this back when I had no kids? I was like, how do you like to manage everything in life? I don't mean just I did do an anesthetic. I kind of meant like without meaning to, to dry. I was like, I kind of need to know how you actually function as like a person who is underneath this as well. So that's the angle I kind of taken for this and that might not interest some of you and it might not be relevant. But I thought I'd include it anyway. So I'm, uh, a Dior, I'm married with two boys, uh, six year old and a one year old and I finished my exam and I'm full time. But if you have any questions about how you fit on the studying with being a train or what it's like to be part time, I can absolutely answer those at the end. Those aren't difficult questions for me to answer. So, your day actually starts the night before is my advice. Have everything prepared, particularly with your kids. So have your glove is ready or your whatever uniform you have your bag, your lumps, your ID badge. There's a real pain. I'm sure you know what this is like. If you turn up at work without an ID badge, you're completely crippled. You, you can't get into the wards. You, you have to rely on your own doorbell. It's noting. So have your ID badge ready. We'll just always leave it in your car if that's how you commute to work in terms of kids have their school uniform ready the night before. Get them, help you with this. Just do it yourself. Um, you know, have them make their snack, their lunch, get their stool, babe ready. I do school dinners like two times a day, but it's so much easier than making them a lunch every day. Hard to be really creative with kids lunches every day and I make my son get out his breakfast bowl and spoon and cereal ready to go and then he can sort himself out in the morning as well. Just there is one less task to do. I gonna do the set up so you can dress yourself as well. Realistically, it's quite an early start when you have kids and you're in anesthetic training. So I'd love to say I wake up like this every morning. I, I sometimes do. I am I, uh, an early bird rather than a dog. II, I often do this like this in the morning though. Uh Not cause I don't wanna go to work cause often I, I haven't had quite enough sleep for my liking. After that. It's sort of a bit of a battle to get everyone ready out the door. It's so easy. If you don't have kids, you do just get ready and let you go. But when you have Children under an anesthetic training, you need to get them out of the house very early in the morning and this can be tricky. It's hard to get good child care in the morning. If you have grandparents willing to take your Children, that is very easy. It's not easy to get a nanny in the morning. There are some childminders to take kids early but not that many. And daycares don't really open until half seven or even eight o'clock. That's not really an option either. So this is a tough part of the day to actually organize, it can be very expensive as well to do lots of breakfast clubs and some school stuff. So they tend to be, um, out the door at the door at a 0.10 to seven, you have to go to grandparents houses or childminder or what, whatever it is you're doing. When you have kids, you need a car to commute because in the car seat. But when I can, I do like to cycle to work, particularly with anesthetics. You're stuck in a theater all day, inhaling the gasses, the anesthetic gasses. I think it's great at the end of the day to get on the bike and cycle home in the fresh air. I think it's very mentally good for you as well rather than being stuck in a car in traffic. And I've done, I've driven and I've taken the car at or sorry, I've driven, I've taken the bike, I think it's actually quicker to commute on a bike. Believe it or not, you can park right at the door. Most hospitals, obviously you're not gonna cycle from Belfast to not unless you're very sick. But I have to say I really did enjoy of commuting on a bike at the Royals. They expect you to have, be ready at 7 30 to work and that's because they want to start early. Other hospitals are different. They will tell you that it a half eight start or a quarter past eight or an 8 a.m. start. This is almost inevitably a lie. They will expect you really by eight o'clock to see your patients, to check your machine to draw your drugs if you rough up a bit. Uh, I don't really like it even if that's what it says on your contract, just ignore it with my advice and it is an early start for theater. The first thing you do is you, it usually says on your ROTA, it's got like an app on your phone called CLW ROTA. And it says clear where you're supposed to be every day. It'll say the two royal or theater five Antrim depending on where you are. You turn up at the theater and there's normally a theater list printed out either in the theater itself or at reception or with the senior nurse. And it'll tell you all the patients you have on the list that morning, it's your job then to get some anesthetic charts and to go on ECR and look up all your patients. It's just good practice. You don't wanna turn up to a patient's bedside. Um, not really know their medical history. And as you know, patient notes, it can be hard to find, it can be almost nothing in sometimes. Whereas on AC r they'll, they'll be evidence that they have investigations for heart failure or COPD or something weird in their past, um, that you weren't expecting. Mm. And lot of blood, you know, you write their blood just check that they don't have preoperative anemia that's not been sorted or, or something back. That might mean that they need to be canceled. You don't go see your patients. Uh This is important to fill, report with them to get consent for the anesthetic and also to look at their airway for any non reassuring features. So, um it, it month since I made this presentation, so I haven't really looked at it but looking at this guy here. No BM I, which is good. She's got it for years. So that will make a end. Just the, the mask. A it's tricky. But also if you have a beard, it could be tiny, a tiny chin. Some men do that, not all of them obviously, but some of them do. Um but his sort of final mental distance and his mental distance looks pretty good. So I'd say he's probably an easy in education. So once you've seen all your patients, which can be tricky to find where they are, it should be somewhere like the royal. You'll go up to the bed place they're supposed to be at and there'll be moves in the middle of the night and not from up to there there car deck just go walking. This can take a long time, it can take an even longer time if you're getting pretty stressed. So you have to talk to the parents when they're very stressed or if there's an interpreter involved at any point as well. The next thing you do is go back to the theater and you check your anesthetic machine. There's a checklist you go through and it's just something you do routinely every day and it's something you get good at anesthetic machine to look complicated. But you guys cannot operate smartphones and gaming and I have no doubt this will knock on boo on for you at all. But it is important to check it. I've seen cases where patients have not been checked and the patient has been put to sleep and there's a leak somewhere. Um, the patient can't be bagged and it's really, uh, I can't imagine, uh, it must be really, really frightening to be honest to be in that situation and you probably feel a bit a bit silly as well because you know, you're probably gonna be cool off and not having your machine and it doesn't take very long mix up your drug. Some people draw drugs for all their patients so they'll have kidney dis issues with each anesthetic for each patient. Set out other. People just do one at a time and do it in between patients through the next month. You'll also have an emergency kidney dish with emergency drugs that usually doesn't get used, but might be, uh, I'm not gonna wonder about which drugs go and which you'll learn that when you the anesthetic, but you have your emergency drug thrown off. That's quite important. Uh I quite enjoy going up there quite positive. Next thing you can to do is stand and sit and wait for the pain to happen. And that's where all the surgeons assists um nurses, radio, like radiologist, anyone who's involved that day, sound around and introduce yourself. Talk about the patients, you go through them one at a time and that's really important because sometimes the surgeons can bring up. So I think is gonna be especially trip or take an extra long or they might ask for a specific bit of equipment from someone. And then it's also a chance for you to point out if you're worried about someone or if you want to request a specific bit of information. So if you got a patient with a physical airway, you might say, actually, I want this brought in, I think we will do this and that tells the surgeons and the other staff that induction of anesthesia and extubation might be a bit longer than usual and look at that into account. Um And this, we discuss things like allergies as well. My wife said I need to go get coffee. And the reason for that is because all roter is supposed to start at nine. It very rarely does. In my experience, I have worked in exeter and Torte in Devon and they started to have it very pu every day. Very organized. The royal is not so organized, I'm sure not so bad. Tends to start on time, but there are often delays, they're very stressful because you think I'm gonna get away late. I pick up the kids, everything's pushed back, but it really doesn't achieve much. My advice is go get tea, go to the coffee room, have a bit of a break. You before that because you might look it up before that for a few hours, depending on if you're on your own or whether you're being supervised or whether anyone's free to give you a break. So rest whenever possible is my advice at some point later and it could be at nine o'clock, maybe be 11 o'clock. It, if there's something really wrong, like your patiently con active, do you find like a heart murmur that no one else has found? But hopefully at some point later starts and the patient comes and you put them off to sleep when you do a nerve block or whatever it is you're looking to do, I'm not going to how you do that at the moment because again, you'll learn that in your in time, but the patient will go up to sleep and then you have that marvelous period where hopefully nothing happens when the patient just stays asleep. And your job is watch the monitor, look at the patients and look at the surgeon. I can, you know, look to see is the surgeon looking stressed because if they are maybe something's wrong, you can ask them every so often get up and wander around. You have to check, but there's not a massive pool of blood lying on the ground that no one's got to tell you about. Uh, let's have a look, go do a little walking up your legs every so often. If you're as a consultant, you'll take breaks often. And when you're a junior, that might be a 15 minute break or a 20 minute break as you get more senior. And if there's only a couple of cases, and so they're sort of 2 to 3 hours long each, what you often agree to do is take longer breaks. And you say, well, you go and do your email paperwork for 45 minutes in an hour and I'll and number 12 or you might say you're a consultant. I'm quite happy to do this on my own. You to stay in the coffee room and I'll call you if, if need be um, they're always available on my mobile phone. I did look at the email consult for help because she and I knew she always answer her email. So I email saying help. Uh and she can, so there is always someone to help you this and as you get more in there, you will want to be on your own being micromanaged. It gets a bit. So, so hopefully this part is quite m and you know, you're, you extubate them, the next patient comes, you put them to sleep for the nerve block, you wake them up so on and so on. If you're only doing one or two cases, it can be quite nice and relaxed. If you're doing the excesses, it can be very rapid and some people like that or you can have brace and you're running a miniature intensive care, which is quite a lot of work as well. You might say central line, you might be most, I have 20 syringe drivers going at once. The reason we have more cause we, we are ring drivers, you might then talk medication to ICU afterwards. It kind of just depends really. Um, most patients wake up and go to recovery at about one o'clock. The morning theater ends. Um, the a later begin, normally most waits, take an hour for lunch, but that doesn't mean you get an hour for lunch. That means you have to try and fit all this in and have lunch that can be tricky. So sometimes this list you stay in the same status AM and PM and sometimes you're sent to a different in the afternoon with a different consultant. Uh, sometimes it's to get different exposure. Sometimes it's just service provision. Kind of just depends. It's great to be in the same theater, but often you problem can agree. Well, the consultant will stay in theater and you can go and see the afternoon patients and have all that ready, drop the drugs in the afternoon. And just save time later on. So it's always really good. If you can suggest that if you're in the same theater all day, it'll look like you're really clean as well. So at about one o'clock, you do the same, you go and you check your patient list, you look them all on E pr, you go see them, check your machine. If it's what they need, drop drugs in hug and then ok, and toilet often there's a delay again. Uh It's almost inevitable, almost inevitable. Um How much big breath um use that time to you can, there's apps for exams, there's journals you can read, obviously. Um you can work on subjects. I do try and do all clinical work at work. I try not to ever do audits or presentations or anything at home. I don't like working for free. So, uh and even things like your, your essential modules, you know, the ones you have to do for, for work, try and get those on your lunch break or on the night shift quiet or something. Um And you can so back here actually back to whenever you're actually doing the anesthetic again. Yeah, so sometime later, so a blockage a delay but sometime later later will start. So you see here this guy is reading this newspaper while given his anesthetic. Nowadays, you see a lot of people on their mobile phones and a lot of people on laptop, like doing things I I don't really like that because the problem is if something ever goes wrong, a jury wouldn't be massively impressed that you're doing scrolling Instagram. Even if you're on your phone looking at journal stuff because you just go, it doesn't seem good. It doesn't sound good. So, what I find doing is you, you'll get anesthetic journals and the D and J and stuff through the letterbox, bring them to work and read them at work because it looks, it looks better than sitting on your phone and also good to read your journals. Anesthetics is one of the three specialties where they actually write the exam based on the journal, the journals are worth reading, they're worth having paper copies and highlighting them. Um So do that with my advice at six o'clock, usually later um at half five. So the theater normally ends supposed to end. Now some consultants will have you stay until the better end and ex the patients, the very last patient, other consultants are perfectly aware that you work much more far from them and they will send you home a bit earlier than they will. But sometimes they're kind of uh so I work great at small. So, and they're kind of set off of you at this point, particularly if you're like, super keen and you've been like asking every question, like, can you tell me how all the work or something? Um Maybe you'll just seem too perky that day and that the time. So, but some consultants find activation very stressful um just to get more senior. So I want you have a spare pair of that to stay. That's fine. The problem is if you're, if you have a partner who is also of the medical persuasion and they also get away late, what happens is you go to pick up your child. I I made it up the bottom. Which pictures of you, this is what your child would look like every day. Your child is the last child to be picked up. The doctor's child is the last child to be picked up from school or after school. Inevitably, they're so bad as well. They, they make you feel so guilty about it. Uh, not much you can do. I'm afraid we having grandparents to school and they pick up their Children. This is a very stressful part of the day because you do worry if I don't pick up my child on time, the fines are very heavy. They tend to be a pound a minute when you're late. Um, and if you're late enough time, sometimes they threaten to refer you to social services and things, which is obviously not a very nice threat. A lot of nurses close at six. the one is fantastic. Uh, and most childminders are really looking to get rid of your kids by dinner time as well. They don't really want to be feeding them dinner. So you pick up your Children, you go home and feed them a really nutritious dinner. Our Children eat nothing but waffles and terrible. I eat really healthy at school. So I figure it probably balances like you don have to try and convince them to do their homework, which is really difficult because they're tired, you're tired. They feel like you picked them up for seven food and they're like bossing them around to do something a bit boring that, that they don't want to do can be really tricky. And then after that, you still got to do like all the normal person stuff. After you put your kids to your kids might not even be in bed yet. You still got to do normal household stuff. Most of you have been out of the house all day so the house shouldn't be too bad, but you still have to empty and do dishes and stuff, get the Children to help you. Finally you get them to bed and hopefully they go willingly for you. Mine are not, mine are off enough until 10 o'clock at night when during about not wanting to go to bed. But once they're in bed, that's a chance for you to have a relaxed dinner and to theoretically do some work if you want to do it. I don't advise doing any work at home. Exams are different. You'll have to study for exams. Nothing you can do about that. Most of that. Is done at home and it depends on what exam you're doing as to what that looks like that revision. But yeah, uh, there's a small window of opportunity there to do some study theoretically. Um, at about 10 o'clock prep for the next day I set at the start, get your clothes ready, your bag, your IV bag, have it all set out ready to go, have the kids stuff ready. Um, just like me and like doing school on your phone until 1 a.m. Um, as soon as I'm knackered and as soon as I go to bed at 10 o'clock because I, I'm not tired anymore and I just want to go on Twitter and Instagram but don't call me, go to sleep. Yeah, there are, this is like a, a normal sort of elective day, but there's other types of those. So when you're on call, you might be covering the emergency list which can be empty or it can have, as I say, 13 cases with literally anything on them. It could be a ation of an eyeball called a Quina, some sort of brain operation. It could be a bone abscess or appendicectomy. Very, very variable could be going to IR as well. When you're on home, you tend to go the bleep, the bleach goes off with pen. So help. I need a can youla put in all the way through to cardiac arrest and um test lab, trauma calls fixations on the ward. To be honest, these days, the emergency days, the on call days is the reason I do anesthetics. I love them. I think it's really exciting. I kind of turning up at half seven and being stressed about getting all the electro cases done if you date of the emergency list is you finish at half five. So you're just doing a normal day, you finish at half five. The other person comes and takes over it. Like, unless there's something really exciting, you're not saying like that's not just not how it works. Some on call days. You're doing a long day when you finish at eight or half eight, but it's the same bag. You know, you're, you're handing over and going home with elective spaces is that there's no one to hand over to the elective cases need finished by the end of the day or one of them need to cancel if you run over the whole of it is really exciting. Sometimes it's really fun stuff. Sometimes it's IC U refer. Um And in some hospitals, the bleach include covering things like holes or obstetric stuff. It depends how big your hospital is. Some days you have audits of teaching, which is really cool. So sometimes you sit there and just listen to stuff other days, you might see something, bring it, everyone loves it if you bring it the outpatient appointment, um perioperative preoperative assessment, they're quite interesting. Some patients come in and they're perfectly well. They, nothing really said of getting a major operation is to talk about the consent for it. Other patients are coming in but they have a terrible airway and kidney disease and heart disease and every disease. And you're telling them that you're, you're high risk of dying from this. So this is our plan if you really want to go ahead uh and then pain, uh we do 10 as well. So sometimes you get to do pain rounds with the pain nurse and a pain consultant with pain clinics with pain procedures less than before COVID. So there is no evidence to do same procedures. But if you're interested in seeing, make it clear early and they can usually facilitate you getting for these things. I actually really enjoy, I don't wanna do it, but as a consultant, but I quite enjoyed doing it as a red. Other guys include covering the maternity unit. Some people love it. Some people don't. I love it that again. It's very like the emergency room. You really don't know what's gonna happen that day cause you care of cancers. Um You know, emergency C section force up. You know, you just don't know, very excited that an epidural. I I'm honestly guys don't worry about, I think I'm gonna be that woman. It just the epidural you will, you'll be able to do them nature. Uh You love nature. They tend to be from eight to half eight good sleep hygiene with kids. That means earplugs and locking your door. So really what other advice to give you that are kind of good for um do the emergency stuff? Uh Only um the consultant at home and I like that. I, I'm, I'm not commonly like to be micromanaged, but they will always answer the phone and they'll always come in. They're very good anesthetic. Um particularly, especially like food, for example, don't always come in. Don't really add on the by the caution. Don't forget uh plan study leave the days where you're off just for personal studies, sometimes you get five days a year, personal study leave, which is why I always try to do each exam in a different academic year to maximize my needs undergo on lots of courses so that, you know, I really want to set each part of the exam once it's very stressful going over to London and set those exams. People leave that hard because the rotation can be three months long and that is a very short period of time, a very short period of time to ingratiate yourself into your department. And if you're off of study and annual leave, number one, you might have pass the rotation, you might not have had enough pas but number two, you don't know anyone in that department either. She'll never be there. You'll only be there on nights and long days and the consultants aren't there. So they'll never see you so make sure to try and take your annual leave. I, the basically you don't know if you're, if you break off from your child with chicken pox, you can't, you know, they can't give them that. So they're off girl, that means you're off three. You definitely just go work and tell them. It's basically just like, um, but I think they won't really pay where you are. Uh, I planned, I think you get up to something crazy, like 17 weeks a year of unpaid parental leave if you want to take it. And I've never done it. But I might this year actually for the first time. And it's supposed to say if you have like a really important wedding abroad to go to or a holiday or something or, you know, even to cover summer holiday, stuff like that or Easter holidays, whatever and also plan there, a plan for fellowships you might enjoy. So there's some very good local ones. You don't have to go anywhere. You can stay in northern Ireland if you want. There's good fellowship in the UK, in the mainland for fellowships in the, in the south of Ireland, in Europe, in a Australia, in Canada. The state is changing. I think the GMC, there's just been, if you wanna go to the state for an elective, I'd look into that sooner rather than later because I think the rules are changing about how easy it will be for all of us UK trainees um trained at UK University to watch it but just other things like what specialty you might like to do. Um Try and find a fellowship that kind of improve for that general advice. Uh Have your own collection of scrubs. Oh, and I was just talking about this. You'll go in, in the morning and there'll be only XXX large stuff or small but like extra small that doesn't fit you. And that's the reason it's been less cause it's like small. So have your own collection at home. It's a bit of a pain, but have your own collection at home and uh your own crops as well, write your name on them very clearly to the have of stolen. I have like a bright blue pair that people aren't likely to nick and I, I've written them on the bottom of them. I actually won't see where that to put people off stealing them. I don't have a condition called foot. It is just to stop people stealing them other advice for your tax returns. If you're not already doing it for every book you buy every course you attend every app, you buy every pen, you buy, washing your uniform, note it all down, buy everything you can online so that you've got those receipts, get an accountant and you'll get thousands back. Honestly, you'll get thousands back a year. You can do it. Five years. We stopped at five years GMC MD U exams, everything. But I think it cost me about 300 lb to get five years of taxes done. And I got a check for 2.5 grand. It was marvelous, outsource everything. So if it costs less for our, than what you are, get someone else to do it, get a cleaner. Really moving. But once you get a cleaner you'll never go back it moving. Um, we have one free. I come home my house look like a show home and it just makes me so happy. Um, and if you've got a garden, you know, pay someone to do your head, you'll not have the energy to come home at night and start trimming unless you really, really love gardening. So I don't know if that's what you're looking for. This is sort of my, my life. Um, and there will be variation between people, you know, if you have lots of family health, if you don't have lots of family health, if you won't take, if you don't want kids partners, your partners, that sort of thing. But, um, I have been in a train without kids and I one with kids. Uh, there's pre and exam and prem mortgage and mortgage. So, um, if you have any questions I can, I can try and answer them that, that me on. That's great. Thank you so much, Anne. Um, that was really good. We haven't had any questions in the chat box, but if anyone has any questions, feel free to throw them in the chat Boxx now. Um, and we'll have you hanging around for a few moments. Um If anything comes up, um, if not, whenever you leave the event, you'll be emailed a feedback form, we would really appreciate if you would fill that out for us. Um, and that way you can get your certificate of attending this evening as well. So thank you to everyone for coming. Yeah, I think so. I don't think you take anesthetics. It is a really good job. They are atrocious, but once you become a consultant, you're down to working more like 3.5 days a week and it's very predictable, you know, you know, say Mondays, Tuesdays, Wednesdays and Friday mornings. So it makes it a lot easier in terms of planning your life if you're a night shift, if your weekend, you know, you go from sort of one and eight on call to one and 22 week maybe. So, it is very different. So if no one has any questions, then we can just leave it there for this evening. But again, there'll be, you can ask questions in the comment box on the feedback session, the session was recorded so you can find it on our med page, uh which you can message as well if anything else comes up or if anyone wants to get involved in planning any future talks or events. Yeah, if you have any comments you'd like us to cover it, you think would be useful. Um Go ahead and ask and, and also most, most m training you meet are more than happy to talk to you as well. Um Most of them really love their jobs and they're very happy to, to chat to you about why they love their job so much. Um So, yeah, good luck. I hope some of you end up being on Friday. That's great. Thank you. Thank you, everyone.