BVA ARCHIVE: Profiles
A day in the life of Declan Costello MA, MBBS, MRCS, ENT
Specialist Registrar, Oxford Deanery.
Until I met my wife, I wasn't really an early riser. We met when we were students, and she would regularly (and insanely, it seemed to me) get up at 6.30. She was doing a PhD in biology, so sometimes had to be at the lab quite early. As a music student, there was rarely an incentive for me to get out of bed that early! But I now enjoy my mornings, and I think of a lie-in as wasted time.
Now that she has shown me the error of my ways, the alarm is set for between 5.00 (if I'm going for a run) and 5.30. It seems crazy to run at that time of day, but it's great to be out on the streets alone, and there isn't really another opportunity to go out. I very much enjoy running. Or rather, I very much enjoy being fit. The actual process of running is quite hard work, but it's worth it in the end! I've done a few half marathons, and I'm planning to do the London marathon in the next couple of years.
After a shower and some cereal, I set off for work (in Reading) in time to arrive at 7.00. That gives me half an hour or so to revise for my FRCS (the final ENT exam which I'm sitting next year) before the ward work begins at about 7.30.
If I have a morning operating list, I race around all of the patients explaining operations to them and asking them to sign consent forms. I am now in my fourth year as an ENT registrar, which means that I have a good repertoire of operations I can perform "solo". For the more advanced operations, I will perform the operations being observed or assisted. It seems obvious to say it, but the surgery is really the most fun bit of being a surgeon. It's enormously satisfying completing a procedure and seeing the patient happy with the outcome. And it's good to push yourself a little further each time, gaining confidence with every operation. Registrars start their 6-year specialist training programme about 5 years after leaving medical school. We spend a year or so in different hospitals, gaining experience from the different people we work with. Moving on every year can be draining, but it is vital to learn different ways of working, and gaining tips from different surgeons.
A morning operating list finishes at about 12.30, and there are often patients to see at lunchtime: emergency admissions that need to be reviewed or problems on the ward. Lunch is normally a fairly hasty affair, often taken whilst signing clinic letters or answering emails.
An average afternoon might involve a clinic: fourteen or so patients to see. Clinics can be fun, especially voice clinics. Highly specialised voice clinics are few and far between, and I have yet to work in a hospital that has a strong interest in the field. So I'm keen to get as much training in voice from other sources. Many registrars go overseas on "fellowships" to get higher training in the sub-specialty of their choice. Some go to do otology, others to learn rhinology or head and neck surgery. I have considered going abroad for a year or two, perhaps to the US, but the visa requirements are now so onerous that it is extremely difficult to get in. On top of that, I'd have to sit exams to be allowed to practice medicine over there, and then there is the family to think of! So rather than going overseas, I think I may spend 6 months or so with a laryngologist in the UK. I will certainly need all the experience I can get in the next few years: there are currently about 40 ENT surgeons in the UK who have completed their training (and are therefore eligible to apply for consultant posts), who have no job to go to. So my aim in the next few years is to gain experience and make myself as "attractive" a candidate for consultant jobs as possible. Fellowships and higher training are good ways of doing this. By the time I complete my training (in 2009), I am hoping that there will be more consultant vacancies available.
Clinic normally wraps up at about 5.30 and I will then talk to the SHOs on the wards to check that there aren't any problems before I go home. I'm a bit of a Radio 4 addict, so I listen to PM or the 6 o'clock news on my way back. But if I don't fancy that, I plug my MP3 player in and listen to (usually) some choral music. I used to sing a lot, and I really miss it now. I was a choral scholar at St John's College, Cambridge, and did quite a lot of singing in London after I'd left Cambridge. So now I like to flatter myself that I could do it all again while I croon along to Lassus or Palestrina!
My wife works in London 3 days a week, so we spend quite a lot of time communicating by email, which seems bizarre. But often, if I don't email a message to her immediately, I'll forget what I meant to say. And with life so frenetic, things do get forgotten or missed.
Having got home and relieved the nanny, evenings with the children (I have three – aged 8, 5 and 2) are fun. We aim to get them all in bed by 7.30, but it seldom works out that way. After dinner and bathtime, there is usually homework to supervise, and of course stories to read. So at around 8 o'clock they are usually in bed reading quietly to themselves.
I usually then spend an hour or two doing administrative things to do with work: registrars are all expected to do research and to participate in other ways. For example, I organise the Oxford region training programme for the registrars. This means setting up monthly meetings at different hospitals around the region, inviting speakers and sponsors and making sure that all the registrars turn up! I also give talks to the junior doctors, nurses and other people within the hospital. I really enjoy public speaking, and researching a topic.
There is obviously also the work for the BVA. For the last 2 years I have helped Julian McGlashan to run the Nottingham Voice Course. I have run a variety of other courses in the last few years (most recently the vocal anatomy and physiology day), and I plan to organise many more. It is good fun (and good experience).
At the end of the evening I pour myself a generous (and usually well-earned) glass of wine and wind down in front of the television. Usually trash, I'm afraid to say, but it's good to turn my brain off. I don't really need a huge amount of sleep – 6 hours is usually enough. I've never had a problem getting to sleep – even the night before important exams, I get to sleep very quickly. Our 2-year-old is now mostly sleeping through the night, so my sleep is only interrupted by the alarm the next morning, or by our cat wailing outside to be let in!
