Children's orthopaedic surgery, paediatric orthopaedics, is a small sub-speciality concerned with surgery for musculoskeletal trauma, pain and deformity. Children are not just little adults – and they deserve the best that humankind has to give. I work in one of the hubs, at the royal hospital for sick children in Glasgow, where six consultants share the on-call (one week in six), serving a large population.
The alarm is set for 6.29am and placed far out of reach, so that to turn it off I actually have to get up. I snatch some cereal and hopefully a brief moment with my own children before driving to work, listening to the Today programme. I arrive at 7.30am, as the canteen opens, and pick up my first coffee of a caffeine–fuelled day. I have three-quarters of an hour administration before the 8.15-8.30am trauma meeting – where the on-call registrar presents the previous 24 hours' admissions, mainly patients with fractures.
This is a management and planning meeting but also key for learning and training. The trainee registrars are lightly grilled; deficiencies in knowledge are probed and the on-call day is planned. The meeting has to be extremely focused. We would start it at 8am but this would render us non-compliant with the European Working Time Directive/New Deal – an example of a poorly thought-out top-down directive having unforeseen consequences compromising training and care. Most frustrations in our service stem from well-meant directives that are inappropriate or unworkable – this generates a large amount of time and effort in bureaucratic fire-fighting.
My working week is split into 10 half-day sessions: three operating, four clinic, two administrative, one supervisory/teaching/research. After a ward-round of inpatients 8.30-9am, my favourite morning clinic is the plaster clinic – for patients (particularly those with clubfeet, developmental dysplasia of the hip (DDH) and cerebral palsy) whose treatment involves serial changes of casts, harnesses or splints. It is intensely practical, so I am fortunate to work with a fantastic team of plaster nurses, a group whose technical skills are often taken for granted.
Packed lunch is in front of a computer, catching up on paperwork and emails. From 1pm, I see patients (and parents) before their operations. There is the pre-operative brief with the anaesthetist and theatre team at 1.30pm. The operating-theatre is a beautiful place, the epicentre of activity, again staffed by a highly skilled and little changing team. An afternoon list typically involves two small cases and one longer one, finishing at 5pm.
Our theatre has a great view across the river: Glasgow University, in front of which, barely 400m away, is the statue of Joseph Lister, professor of surgery. With a small patient series of open fractures Lister introduced the world to antisepsis, opening the age of modern surgery.
After a post-operative ward round of patients, there is usually time to review the focused piles of investigations and scans, organised by a fantastic secretary. I leave work at about 7pm, a good time to miss most of the traffic.
Sport has always been a necessity for me, and I will do half an hour on the rowing machine at least every other evening. At the weekend I really enjoy playing squash with my children. I wish I was a lark, but I am in fact an owl, and do most of my written work in the small hours – it's a good time to focus. Everyone else is asleep.
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