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 short...as 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!

Week 1 - Anaesthetics.

Interesting week here in England. Had a snow storm the day before my first day of placement. A lot of my friends got a snow day, but I haven't heard from my hospital so I ended up leaving later than usual for the central hospital. Because of all the snow - it was actually a very pleasant drive as there were hardly any cars. What is usually a 30-40 minute drive, ended up taking me 10 minutes. I was thinking to myself that I was such a genius to drive as the roads were clear (bit slushy)...until I got to the hospital. The parking lot wasn't cleared and it was packed with snow/ice/slush. Made it a bit daunting to park my car. When I got out of my car, I stepped in about 2" of snow...well there goes my black shoes. Tippy toed my way into the hospital only to overhear people saying that there will be more snowfall in the afternoon. "Shit." was probably the only thing that came into my mind. And then I thought to myself: "How am I going to go home...what an idiot. Shouldn't have driven."

Anyways I made it for my induction and most of us managed to get in. A few people got snowed in as they live on a hill and couldn't make their way. We got our logbooks which has various skills that we need to be signed off on by the end of 4 weeks in anaesthetics/critical care. Such things include putting in cannulas, inserting a laryngeal mask airway (LMA), intubating, drawing up antibiotics, etc. I was quite motivated to get my logbook done as quickly as possible so I walked into the theatre I was assigned to - ready for action. I was then greeted by a consultant anaesthetist, who seemed a bit annoyed. I was quickly told to leave and come back in an hour. Almost felt like I smacked into a brick wall. It kind of threw me off and I got nervous again as the consultant didn't seem too friendly. I went to get some food and returned an hour later and was promptly told to go find a patient in the ward and get a patient history from him. In my head I was getting annoyed as I wanted to work on my logbook, not go and speak to patients. By the time I returned to theatre the consultant had relaxed and apologized to me for being a bit rude earlier. I really appreciated the apology and the consultant gave me a few tasks to do such as mixing and drawing up antibiotics. I was then taught how to insert a LMA and how to hold an oxygen mask to the patient's face. It was really good and exciting. I also got a lot of teaching about regional and local anaesthetics during surgery which was an added bonus. Because of the snowfall, some patients cancelled and we ended up having a short theatre list. I was out of the hospital by 3pm and luckily the snow had just stopped, so I made a run for it before my car gets snowed in. Thankfully made it home with my car (to the surprise of many). Also had the feeling of: "not so dumb after all!"

I would say I had a really good first day as I got a few things signed off and was ready to go for day 2. Unfortunately, it was a bit of a mess as there was teaching going on and the lists were starting later than usual (and I made the effort to go in for 8am when lists weren't starting until 11am). Then I realized that this is something everyone has to accept - as a student and as a doctor. Not everything will go to plan and you just need to adapt and find something productive to do. There were a few theatres running so I decided to go for a wander. Funny enough I ended up scrubbing in for a few procedures and assisting. Yay...but obviously deviating away from my placement goal: to learn anaesthetics! It was a nice bonus and certainly better than sitting in the coffee room for 3 hours. I at least did something productive and I felt like I was helpful. Later in the day I met up with a different anaesthetic consultant and I got a bit of teaching (not as much as I had hoped) and unfortunately did not get a single thing signed off. Great - here's hoping next day will be better. Next day...same thing. I tried to hint to another consultant anaesthetist that I would like to get involved as I had put on my gloves and stood at the top of the bed ready to lend a hand. Instead, I was ignored. I asked if I could insert a few cannulas and was told that it would be too difficult. By now, I had lost a lot of motivation and ended up just standing around for the whole day. I don't think this is really the anaesthetists fault as they are all very nice people and love teaching. I learned loads, it was just a bit more annoying that I couldn't do anything practical. Just another thing as a student you have to accept - sometimes you can't get in on everything. Unlike my group mates, I haven't been kicked out of theatres due to too many students. I've been lucky that I've still been able to stick around and observe and get some teaching. I've also been in orthopaedic theatres so the orthopaedic surgeons were also teaching me about their procedures, which I found really interesting. Essentially other than the first day, this was the story of my week. Just not getting any opportunities to do practical skills.

So I went home and thought what I can do about this as I have a log book that I need to complete. I think next week I will approach with a different mindset and make it clear first thing to the consultant that I am very keen on helping out and trying out some practical skills. Sometimes being subtle and polite doesn't work so I'll just have to be brazen and go for it. Fingers crossed that I will get to do a bit more next week!