The English Patients

(7-8-06)

I completed my first week as an "Honorary Registrar" yesterday. The differences between England's NHS and the American health care system are striking. One characteristic common to both countries, however, is the state of financial crisis. I watched a story on the local news channel shortly after arriving in England that described the layoffs that were going on with doctors and nurses throughout the Oxford community. I was impressed by the state of uproar that the community seemed to be in, but would have never guessed that these "redundancies" were going to affect 2 of the 3 Consultants (Attendings) on my service. Unbelievable. I mean the JR seems to be worse off than Wernham Hogg. Although it does not seem to be as difficult as I would have expected to obtain testing for patients, every CT scan and procedure that we order has to be approved by a radiology consultant. The length of waiting times are much greater here than in America, both for surgical procedure and for clinic visits. My first experience in the operating room came on Wednesday, when I participated in a laparoscopic cholecystectomy. Probably the wierdest thing to get used to was walking into the theatre without a mask on. I probably would have felt more comfortable walking around Times Square in my whitey tighties. The funny thing is that after awhile you kind of get to where you actually prefer that unconstricted feeling. Probably the most awkward moment came when the consultant I was working with came around the table and stood next to me. One of my good friends at Hopkins used to tell a story about one of the breast surgeons back home who used to operate that way. He described it as similar to walking into a restaurant and seeing some elderly married couple sitting next to eachother at a booth. It definitely wierded me out a little, particularly because most of my movements required reaching accross the table in order to manipulate a "grasper" that was apparently not made for grasping tissue. In spite of the adjustments, the gallbladder came out pretty easily. As I was preparing to close the skin, they handed me a straight needle--something I hadn't seen since my 8th grade home economics class. But by far the biggest adjustment to working over here is the differences in vocabulary. I've had to resort to putting together my own travel dictionary:
Elevator=Lift
Follow the drain output=Chase the drain output
Cap the bile drain=Spicket the bile drain
I've lost exactly 21 pounds of weight=I've lost a stone and a half
That's a load of crap=That's a load of bollucks
That's the bomb (or "tits" in some places)=That's the dog's bollucks
Electrocautery=Diathermy
Yankeur<>Wanker
Thyroid retractor=Langenbeck retractor
Reinhoff=Clip
Balfour retractor=?????? (still working out the spelling on that one)