Last week wasn't so bad. I had a capable registrar who'd been doing this job for ever, and he knew lots of things, and was calm to boot. This week he's gone on to be the geriatric registrar and in his place is a temporary registrar for two weeks before she in turn goes off on maternity leave.

Now it's chaos. I wish she would stop asking me what to do.

It's not clinical decisions or diagnosis, thank goodness, but mainly queries about how the hospital runs. What should we do in order to get this done? Where is this meeting held? Who is that doctor? Which is fair enough, she's never worked in this hospital before, but then I'm hoping she gives away the habit of becoming very defensive whenever I start to raise my tone just a notch. Even though most of the time I'm merely trying to state my point and to make things clear, she seems to think that I'm becoming angry and she quickly says "No that's fine if he has done it like that but I can't understand why," and that's when I start taking deep breaths.

Yesterday was made worse because we had an 'observer', who as I understand it is an International Medical Graduate (or IMG - someone who holds a medical degree from somewhere in the world apart from Australia) who hasn't yet passed the qualifying exams necessary to work as a doctor in Australia. So they come to the hospital but stand aside and 'observe'. Our observer was a quiet lady in a headscarf who seemed quite lost. She'd just come up from Emergency Department and it is quite different up on the wards; I didn't have a lot of time to show her stuff, because I was too busy pushing my registrar to do her own work and to stop hovering over me, as well as tied up with a late post-take ward round and an afternoon outpatient clinic.

I didn't even get the observer's name.

Maybe today will be better. We won't be on take again until Wednesday, thank goodness, so we have a couple of days to breathe. I lost my temper yesterday at the coordinator nurse, because the non-doctor staff had somehow made a decision about one of my patients and plastered a message on her file that read: "To go to [other hospital] Mon/Tues?" Now when you do that, I consider that someone somewhere has done something to organize this. Patients don't just magically move, you know. So when I spoke to the coordinator nurse yesterday at noon for our daily update on patient movements, he calmly suggested that maybe a doctor needed to ring the other hospital to ask if she could be transferred over? I stared at him. "Do you mean to say that nobody has rung the other hospital, and nobody has done any paperwork, and you haven't asked me to do it the entire morning while I've been on the ward, and now that I have half an hour to Grand Round and a clinic in the afternoon you want me to do it all now?" He just sort of blinked at me and I shut my plastic box file a lot harder than I needed to, took a deep breath, and walked down the corridor swearing under my breath while the observer tripped along behind me wondering where I was going. To make it worse someone (probably the surgeons) had misplaced her file and I had to search for it for ages before I finally found it in completely the wrong side of the ward. I rang the other hospital and tried my best to sell a patient over the phone and they assured me there were no beds today but that they'd get in touch. We ran off to Grand Round, and popped back in with five minutes to spare before clinic, only to find that the bed managers between the two hospitals had somehow wrangled a transfer, and my patient was ready to go in two hours. Two hours! I wrote the fastest discharge summary of my life while my registrar figured out her pain control, and finally, finally we had everything organized. We were 20 minutes later to clinic than our consultant but he didn't mind, he said he knew the ward was a mess.

Oh, not as much of a mess as my brain.