Saturday, February 16, 2013

Final Week - Anaesthetics

Wow these last 4 weeks have blown by. Like I've said in my last post, I've seen a great improvement in my practical skills and confidence in doing invasive procedures. It really is true: practice makes perfect!

Because I have made quite an effort to get my logbook signed off early, I took my final week in anaesthetics as a "flexible week". I had a sudden urge to go watch some orthopaedic surgery so I decided to go observe a list. As I walked into the orthopaedics theatre and asked the consultant if I could observe, I was then offered the opportunity to scrub in (which made me very happy). It was so good to be back in orthopaedics and scrubbed in. Geek moment: I was pretty excited while I was scrubbing in. It brought back the good memories I had from last year whilst on my Orthopaedics attachment. Last year, I only helped drape the patient once or twice as there was usually a registrar there, so I would stand back and watch. Let's just say draping a patient for Orthopaedics isn't the "easiest" thing when you're still quite new at it. Because there are plastic walls around the operating area, you really have to be aware of your surroundings to make sure you stay sterile. The draping is also quite the task itself as there are quite a few layers to put on and I will admit that it required a lot of concentration and focus for me to make sure I maintained sterility. When the draping was complete and I didn't screw up, I couldn't help but feel like this:

Anyways, we did an exchange of a total knee replacement. It was fairly straight forward and it was nice being able to assist. Just felt really good. The tasks I were doing were fairly simple, for example, suction, diathermy, etc, but you still feel like you're a way. At the end I got to do some suturing and close up the wound. Admittedly quite rusty, but after 2 dodgy stitches, I dusted off the cobwebs and got back into it. Of course, being a responsible person, I redid the 2 dodgy stitches (in case you were wondering...). The consultant checked my stitches over and I got the nod of approval and then tidied up. The surgery took about 1.5-2 hours, but it certainly felt much shorter. We took a lunch break and I bumped into my anaesthetic group mates. They noticed that I was looking quite happy and some of them know me quite well could guess immediately that I got to scrub in and assist in surgery. I then bumped into one of my good friends and even he asked why was I oddly happy. When I sat down for my lunch and did a bit of reflection - I really do think surgery is for me. It makes me happy and I really enjoy it. I mean I've seen a few exchange TKRs last year, and it just doesn't get old. Every case is different. We had another operation in the afternoon which was quite straight forward. By the end of the day, I was quite tired and my feet were sore, but I was happy. I felt like I had a productive day. I felt like I learned a lot. I was at the hospital since 8am and got off at 5pm. I would usually be craving to go home, but after the list, I wanted to follow-up with the patients in recovery/post-operative surgical unit. It was a really good day. Probably the happiest I have been on placement this year.

The next day was a huge contrast. I went back to anaesthetics and met up with the consultant anaesthetist at 7:45am. The first thing he told me was that he is too busy and that there won't be any opportunities for me to get any hands-on. He also told me to be prepared to stand to the side for the rest of the day. I couldn't help but get annoyed as I made the effort to come in at 7:45am, ready to learn, and then to be told that I won't get to do anything. I thought the consultant was maybe just over-exaggerating, but I quickly found out that he really did mean it when he said I will be standing to the side. I just stood in the anaesthetic room in one corner and watched everything....and proceeded to zone out. All I could think about was that it was a huge waste of time. Then 2nd case, same thing. I was just stood there. I even asked if I could help out and was promptly ignored. I made the decision that I could be more productive if I went home. By 12pm, I grabbed my bag and told the consultant that I'm going home. He wasn't too impressed that I was leaving early, which surprised me. I was not learning anything and he wasn't teaching. What was the point in me sticking around? I firmly told the consultant that I could be a lot more productive at home and complete some of my assignments. I was fed up and just left. In a way it was rude of me to do that, but at the same time, the consultant knew he was going to have a student around and if he doesn't want a student around, then say something to the administrators so he doesn't get assigned a student. Ridiculous.

Despite the sour ending to my week, at least there was a very high point in this placement, which was unfortunately not anaesthetics related. I'll just treat the orthopaedics day as a treat to myself for getting all my work done early. A few years back, I used to want to do anaesthetics, but this attachment has reaffirmed that it isn't for me. I can see why people would enjoy it, but I really do think I am more suited for surgery. I just enjoy being hands on and fixing things. I enjoy the theatre life, but not sat at the head of the table. My next placement is A&E for 4 weeks. Again, I am quite nervous as I have been placed in the main hospital, which is quite busy. I know what to expect, but I'm not sure if I'm ready for its quick pace. We'll see. I'm excited in a way. Plus more opportunities to work on my clinical skills!

Monday, February 11, 2013

Slow Week - Anaesthesia

To be fair, every placement has a "slow" week. Mine is usually the first week...somehow out of my 4 week placement, I managed to have another slow week. Last week, I spent most of my time checking out the intensive care unit and the high dependency unit. I'll just say in my opinion, it is probably the "less exciting" part of the job. Lots of ward rounds! I really don't know what to take away from this week. Having said that, I did manage to get a lot of physiology teaching from a consultant anaesthetist. It was actually a really good refresher. The way he taught was based on quizzing (which I hate, but love at the same time). I was picked on most of the time as I was the only medical student and that the knowledge should be "fresher" in my mind. It made me realize that I actually haven't really forgotten about physiology. From the quizzing/grilling, I realized that I just lack confidence in my answers and should just be brave and say what I think the answer is. It's a shame that it takes massive pushing and pressure for me to get an answer out. Guess it's one thing I need to learn and obviously shows I need to hit the books a bit harder to build some confidence in my knowledge. The foundation knowledge is definitely there and I just need to "go for it".

Thankfully to end the week, I got to go back to theatre and was placed with a really good anaesthetist who let me do a lot of skills. I was putting in all the cannulas, holding the oxygen mask, and inserting LMAs. It felt really good. In the first week, despite being very determined to get some hands on, I was quite scared and nervous performing these skills. Now, I'm on it the minute the patient comes to the anaesthetic room. Gloves on. Equipment ready. Ready to go! It also showed me that with practice, you'll get better at the skills. I had to cannulate a tricky patient. I missed the vein on entry, but managed to salvage it and got the cannula in without needing to try in a different spot. Added bonus was that the consultant complimented me on it, so it was a definite boost to my confidence level! Thinking back to the last 2 weeks and seeing my placement come to an end - I think I've made leaps and bounds in terms of clinical skills. I built a lot of confidence in my clinical skills and in general feel just a bit more competent. My day in theatre really showed me how far I have come from the beginning of placement and I think I have accomplished what I have set out to do - to improve on my clinical skills.

I do realize that my posts have been fairly to be honest - there's not much to really talk about. I don't get to speak to as many patients as most are asleep. This placement was mainly refreshing my pharmacological and physiology knowledge and improving on my clinical skills.

Sorry for the boring read! I promise the end of this week's post will be more interesting!

Sunday, February 3, 2013

Having a Bad Day?

Medicine is a constant reminder of how fragile and unfair life can be. Life can throw curve balls and do some pretty unexpected things. I was in clinic and met a lady who is 40 years old and have been getting treatment for cancer. Unfortunately, it has been found that it has metastasised to other parts of her body such as her bowels and her lung. What really struck me was that as I entered the room, having read the notes before seeing her, I was expecting a frail lady who would look quite ill. Instead, I was greeted with a very healthy looking lady. If I had seen her in the hallways, I would not have guessed she had been battling cancer for almost 2 years and now facing another fight against the metastases. While going through her medication list, she was on high doses of analgesics and one can imagine how much pain she is usually in. As we got further into the consultation, what once was a calm looking lady turned into a nervous and worried person. She is supposed to undergo radical surgery in a few days and I really do not blame her for her nerves. I was taken aback by how calm she was at the beginning. It really puts things into perspective. I had a bad week last week with back pain, but after hearing the patient's story, my back pain seemed like nothing. It is nothing compared to what she's going through. And it really amplifies the fact that if you think you're having a bad day, there are people having a much worse day than you. It's easy to forget how fragile life can be. 40 year old woman - most are fit and healthy. Cancer is something still seen as a disease that affects the older population. It was inspiring to hear about her fight and her courage. Pretty sure I didn't whine/complain about anything for the rest of the day.

Life can throw curve balls affecting you physically and your health. But I wanted to talk about mental health. By being in a stressful job, it is important to keep your mind "happy" and not allow work overwhelm you. Your emotions can greatly alter your way of  functioning. Recently, there has been a lot of mental health awareness campaigns going on especially back home in Canada. I personally know quite a few friends affected by mental health issues such as depression. I thought it would be worthwhile for me to write a mini blurb here and raise awareness to those who read my blog. Statistically, about 1 in 4 students are affected by depression and approximately only 1 in 4 people seek help. The main reason for the lack of seeking for help? Stigma. Mental health is still a "taboo" subject and it shouldn't be one! It is a common problem affecting many people. Not many people want to speak up and get help. You can't just "laugh" off depression or mental health illness. I know way too many people suffering with this. What bothered me was how even in the health service, health professionals are almost afraid to ask about psychiatric illness. The number of times where I've seen various professionals very quietly ask if there is any history of psychiatric illness or if he/she suffers from depression. We ask about heart/lung/bowel problems loud and clear, but when it comes to mental health it gets all "hush hush". If there wasn't this "stigma" surrounding mental health, will there be more people seeking for help? I would like to think yes. I've had friends who suffered in silence and I have nothing but praises for those who gathered enough courage to seek help. From what I hear, it can get very dark and lonely. There is so much help out there. People shouldn't be suffering in silence. Stigma is unacceptable. The reason for raising awareness is to eradicate the stigma associated with mental health. 1 in 4 people are affected. That is common. Look at your group of friends. Live in a house with 3 others? Do your part and raise awareness.