Shocker - I'm back! Most of you probably thought I fell off the planet or medical school had simply killed me. Actually what had happened is that after my placements in May I had left for my medical elective for 2 months. I went back to Canada to do my medical elective in..........you guessed it: Orthopaedics. It was tough - and that's putting it lightly. I have not worked as hard as I had during my medical elective than any of my last 4 years at medical school. So once I got back I was seriously burnt out while my friends were burnt from their lovely sun filled elective in the beautiful/tropic parts of the world such as: Thailand, Vietnam, Fiji...I am feeling my blood pressure go up again. To put it in even more simple terms - I was miserable during my elective and very jealous of my friends who had a tropical and fun-filled elective to discover themselves.
Why was my elective so tough?
Well North American medical school will always have its stereotype to uphold. My mornings started at 6:30 am and my day didn't end until 6pm and that's me sneaking off early. Despite being a visiting elective student I was expected to still do 24 hour on-calls. Yes there were a few days especially in the first 2 weeks where I wanted to go and hide in a corner and cry. I've never been told off so much in medical school as much as I had during my first 4 week rotation. Apologies I have to leave out details as it will make me very easily identifiable if I start specifying EXACTLY what sub-specialty I was doing. I remember telling my parents several times I would quit. I nearly walked out of clinic many times. I walked out of the operating room once after being unfairly treated. This elective definitely pushed my limits to the max. When I reached my 2nd rotation of 4 weeks - I was back in my comfort zone. Let's say the first 4 weeks was a very steep learning curve and one I hope to never go through again. Looking back at it, I'm glad I got my ass-whipped as not only did I never work so hard before, but I have never learnt so much before in such a short amount of time. I had to gain A LOT of self-confidence and was pushed to the deep end of the pool during my elective and I'm glad the consultant pushed me that hard. I would have never learned...but with that, I sacrificed the enjoyment of the elective. I guess it's a fine balance.
When I returned to the UK I was just so burnt out. I didn't get much of a summer holiday. I was back to placements and well let's just say placement seemed extremely SLOW compared to Canada. I had a hard time adjusting back and consultants thought I was overly too proactive. It's a very different system here in the UK. In Canada I felt like I had to fight for my learning opportunities and I learned by falling flat on my face a million times. In the UK, we are spoon-fed our learning opportunities. There isn't a huge competition atmosphere in the UK. I was with other medical students in Canada and I found myself fighting to get to scrub in and fighting to see patients. As a student in the UK I feel like sometimes we take it for granted the amount of learning opportunities we get. Anyways there isn't much to talk about my elective. If I had to sum it up in one sentence it would go like this: Worked my ass off, but came out more mature and wiser and perhaps a hell lot more worn out. To be honest I still don't know what to think of my elective. Don't get me wrong, I was lucky to have got an elective in Canada in a major city in a very popular specialty, so I don't regret it at all.
Hopefully I'll start updating a bit more, however, final exams are coming up so I am a lot busier than usual now. Currently doing my General Practice rotation so who knows maybe I'll find time. Sorry again for the lack of updates...just had a rough few months.
Showing posts with label surgery. Show all posts
Showing posts with label surgery. Show all posts
Sunday, September 15, 2013
Friday, May 3, 2013
Urology - Week 1
Sorry for the lack of updates. The weird thing with this rotation is that I'm running through all the other specialities: ENT, Ophthalmology, Urology, Haematology, Dermatology, and Oncology. I only get either 1 or 2 weeks in each specialty. You can imagine I only get a quick glimpse of everything and so far nothing interesting has happened.
Because I am now on Urology and have got 2 weeks here, I thought it would be worth doing a bit of an update. So we were inducted into the specialty on the Monday and were pretty much scared stiff. The urology department at our hospital is an academic department as well so they have academic ward rounds and really encourage full participation from students. You will probably wonder: "So what's wrong with that? That's great isn't it?" Well yes, that's great as we get loads of teaching, but that means we got to work twice as hard as we are expected to do presentations. I don't mind working hard, it's just our presentations have to be a case study on an inaptient. With how our schedules are, we don't have much time on the wards as we are timetabled to be in clinics/theatre. We were also told that consultants expect us all to be prepared for clinics/theatre and expect us to do our reading beforehand.
Biggest heart sinker? On theatre days we are expected to go to Theatre Admissions Unit (TAU) at 7:30am to get a brief patient history for all the patients on the list and be prepared to tell the surgeon all about the patient in theatre. Don't get me wrong, I love going to theatre, I just don't enjoy this horrifically early wake-up. I've been quite lucky with not needing to go to TAU in prior placements as the consultants I have been placed with don't require me to go to TAU and talk to the patient ahead of time so I usually get to theatre at around 8:30am. Anyways so Tuesday was my theatre day and I was placed with the academic lead for Urology (perfect...). Being a bit scared, I obviously head to TAU at 7:30am and talked to the 2 patients who were on the theatre list. As I was finishing up the consultant shows up and was actually quite surprised to see me in TAU. I was then promptly quizzed about the 2 patients and about their procedures. Luckily I did a bit of reading before I saw the consultant so everything was fresh in my mind. Think I impressed him as I got the nod of approval and the brief grilling seized.
At theatre, I met with the registrar and was warned I will probably get a full grilling on anatomy and should do some reading while the consultant isn't around. Read up on the prostate and bladder, which wasn't too difficult. I've always remembered the general rule for surgery is to know the blood supply, lymph drainage, and nerve supply for that organ, and you'll be alright. 30 minutes into a cystectomy, the consultant asked me for the blood, lymph, and nerve supply for the bladder. Check. Check. And check. The greatest bit was when he looked over to me in awe and proceeded to go quiet until lunch time. Just going to dust my shoulders off now. Now here comes a curve-ball, I was then shown a muscle and was asked what it was. Thankfully due to my "love" for orthopaedics and hip/knee anatomy, I immediately recognized the muscle as the psoas. Then another dead pan from the consultant who then went quiet again. Then he asked about the path of the Obturator nerve and what it innervates. Easy as I've been quizzed on that before by an orthopaedic consultant for fun not too long ago. As I finished my answer, the consultant put his scissors down and remarked that he'll sign me off for the next 2 weeks. He seemed really impressed and well I obviously felt good for once and not like a complete idiot. I was quite lucky with the questions though as usually it is a hit or miss. Was a fairly good day!
Rest of the week was fairly...dull. Went to a haematuria/cystoscopy clinic and did a bit of ward work, where I found myself being the cannula/bloods monkey again. Was nice being able to put cannulas in again as it has been awhile since I've put one in and I was worried I would lose the skill, but looking at my 100% in one go rate on the ward, think I'm still alright! All in all - okay week. Not very stimulating. Not very interesting. Escaped presentation - think it was partly due to my "good play" in theatre. Hopefully next week will go just as well!
Because I am now on Urology and have got 2 weeks here, I thought it would be worth doing a bit of an update. So we were inducted into the specialty on the Monday and were pretty much scared stiff. The urology department at our hospital is an academic department as well so they have academic ward rounds and really encourage full participation from students. You will probably wonder: "So what's wrong with that? That's great isn't it?" Well yes, that's great as we get loads of teaching, but that means we got to work twice as hard as we are expected to do presentations. I don't mind working hard, it's just our presentations have to be a case study on an inaptient. With how our schedules are, we don't have much time on the wards as we are timetabled to be in clinics/theatre. We were also told that consultants expect us all to be prepared for clinics/theatre and expect us to do our reading beforehand.
Biggest heart sinker? On theatre days we are expected to go to Theatre Admissions Unit (TAU) at 7:30am to get a brief patient history for all the patients on the list and be prepared to tell the surgeon all about the patient in theatre. Don't get me wrong, I love going to theatre, I just don't enjoy this horrifically early wake-up. I've been quite lucky with not needing to go to TAU in prior placements as the consultants I have been placed with don't require me to go to TAU and talk to the patient ahead of time so I usually get to theatre at around 8:30am. Anyways so Tuesday was my theatre day and I was placed with the academic lead for Urology (perfect...). Being a bit scared, I obviously head to TAU at 7:30am and talked to the 2 patients who were on the theatre list. As I was finishing up the consultant shows up and was actually quite surprised to see me in TAU. I was then promptly quizzed about the 2 patients and about their procedures. Luckily I did a bit of reading before I saw the consultant so everything was fresh in my mind. Think I impressed him as I got the nod of approval and the brief grilling seized.
At theatre, I met with the registrar and was warned I will probably get a full grilling on anatomy and should do some reading while the consultant isn't around. Read up on the prostate and bladder, which wasn't too difficult. I've always remembered the general rule for surgery is to know the blood supply, lymph drainage, and nerve supply for that organ, and you'll be alright. 30 minutes into a cystectomy, the consultant asked me for the blood, lymph, and nerve supply for the bladder. Check. Check. And check. The greatest bit was when he looked over to me in awe and proceeded to go quiet until lunch time. Just going to dust my shoulders off now. Now here comes a curve-ball, I was then shown a muscle and was asked what it was. Thankfully due to my "love" for orthopaedics and hip/knee anatomy, I immediately recognized the muscle as the psoas. Then another dead pan from the consultant who then went quiet again. Then he asked about the path of the Obturator nerve and what it innervates. Easy as I've been quizzed on that before by an orthopaedic consultant for fun not too long ago. As I finished my answer, the consultant put his scissors down and remarked that he'll sign me off for the next 2 weeks. He seemed really impressed and well I obviously felt good for once and not like a complete idiot. I was quite lucky with the questions though as usually it is a hit or miss. Was a fairly good day!
Rest of the week was fairly...dull. Went to a haematuria/cystoscopy clinic and did a bit of ward work, where I found myself being the cannula/bloods monkey again. Was nice being able to put cannulas in again as it has been awhile since I've put one in and I was worried I would lose the skill, but looking at my 100% in one go rate on the ward, think I'm still alright! All in all - okay week. Not very stimulating. Not very interesting. Escaped presentation - think it was partly due to my "good play" in theatre. Hopefully next week will go just as well!
Friday, April 12, 2013
1 Week ENT.
Well I'm back to "work". Had a week of ENT...which has been fairly uneventful. Went to a few adult and children ear/head/neck clinics. The clinics actually run quite quickly, but I'm not sure if it is because the surgeons are efficient or the cases in general are more simple. Think it is the former. Anyways it has been a fairly frustrating placement. Because it is half-term, a lot of the consultants are away so a lot of clinics/theatre lists are cancelled. Obviously being a medical student, we don't get told about the schedule changes, so we don't find out until we get to clinic/theatre. Just one of those skills you need as a student: Adaptation. Need to be able to think on your feet and figure out what are you going to do with your time. I found myself running between hospitals quite a bit - I guess it's a good workout! Absolute pain though.
To be entirely honest - my impression of ENT surgeons before I started the placement was: "a bunch of arrogant surgeons". I am so glad I was proven wrong. They were all really nice and are really keen to teach. Don't know where did I get that impression from. Then again most impressions/stereotypes are no longer accurate. One thing I will admit is that the surgeries that ENT surgeons do are remarkable and beautiful. So delicate and intricate, but it works! I assisted in a myringoplasty and laryngectomy. Just amazing. Myringoplasty is where a perforation in the ear drum is replaced by a graft which you get from the fascia lying over the skull. Everything is done under a microscope. Admittedly my eyes were hurting after, but it was quite a beautiful surgery. They work in such a small space and still manage to do it with a lot of precision. Also watching them place a graft over the perforation and finding ways to support the graft while it heals with the rest of the ear drum...just can't describe it in words. Whoever thought up of these surgeries - genius. On the other hand - laryngectomy - massive incision requiring neck dissection. Saw so much great anatomy. Also got to scrub in and close up in the end (after hours of retracting). This surgery showed me why some people absolutely dread surgery. Never understood it until that day. My hands were cramping so much that I couldn't feel them anymore at one point. Guess my reward in the end was closing up. Suturing will always make a keen medical student's (interested in surgery) day better. Got to learn a new type of suturing technique, which is quite challenging. Took a few goes for me to get a hang of it, but eventually I managed to get a hang of it and I don't think I did too bad. Got it checked over, and got the nod of approval. Was quite satisfied with myself!
The thing I noticed in my very short 1 week stint in ENT was that you see a lot of cancers in adults and a lot of ear infection/tonsillitis in children clinics. Such contrasting conditions. Overall the attachment was too short...but in a way I was relieved that it was over because it was so disorganized. I was really fed up with running around looking for the right clinics and going between hospitals to go to a different theatre list. Then the consultant wouldn't be expecting a student and you have to explain, etc etc. Life of a medical student!
To be entirely honest - my impression of ENT surgeons before I started the placement was: "a bunch of arrogant surgeons". I am so glad I was proven wrong. They were all really nice and are really keen to teach. Don't know where did I get that impression from. Then again most impressions/stereotypes are no longer accurate. One thing I will admit is that the surgeries that ENT surgeons do are remarkable and beautiful. So delicate and intricate, but it works! I assisted in a myringoplasty and laryngectomy. Just amazing. Myringoplasty is where a perforation in the ear drum is replaced by a graft which you get from the fascia lying over the skull. Everything is done under a microscope. Admittedly my eyes were hurting after, but it was quite a beautiful surgery. They work in such a small space and still manage to do it with a lot of precision. Also watching them place a graft over the perforation and finding ways to support the graft while it heals with the rest of the ear drum...just can't describe it in words. Whoever thought up of these surgeries - genius. On the other hand - laryngectomy - massive incision requiring neck dissection. Saw so much great anatomy. Also got to scrub in and close up in the end (after hours of retracting). This surgery showed me why some people absolutely dread surgery. Never understood it until that day. My hands were cramping so much that I couldn't feel them anymore at one point. Guess my reward in the end was closing up. Suturing will always make a keen medical student's (interested in surgery) day better. Got to learn a new type of suturing technique, which is quite challenging. Took a few goes for me to get a hang of it, but eventually I managed to get a hang of it and I don't think I did too bad. Got it checked over, and got the nod of approval. Was quite satisfied with myself!
The thing I noticed in my very short 1 week stint in ENT was that you see a lot of cancers in adults and a lot of ear infection/tonsillitis in children clinics. Such contrasting conditions. Overall the attachment was too short...but in a way I was relieved that it was over because it was so disorganized. I was really fed up with running around looking for the right clinics and going between hospitals to go to a different theatre list. Then the consultant wouldn't be expecting a student and you have to explain, etc etc. Life of a medical student!
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 helping...in 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!
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 helping...in 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!
Saturday, January 26, 2013
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!
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!
Sunday, January 20, 2013
Back to Work.
So I'm back from my winter holiday and have had a week of lectures which was an introduction to Specialties and Acute and Critical Care Medicine. Essentially how this year works is that I will go through 4 core rotations: Acute and Critical Care Medicine, Specialties, Community and Palliative Care, and General Care Medicine. Each core is about 8 weeks each. Within each core there will be sub-attachments/sub-specialties. Anyways I'm starting with Acute and Critical Care Medicine and my first 4 weeks will be in Critical Care so I will be getting to know the anaesthetists! Then my next 4 weeks will be in A&E/ED (emergency department). I am quite excited about this year as this year is quite focussed on specialties and I will have plenty of opportunities to be in theatre this year. Yay!
To give you an idea what sort of lectures we had this week - we went through topics in Urology, Opthamology, Haematology, Anaesthetics, Dermatology, Trauma, Oncology, Infectious Diseases, and ENT. To be fair, covering all of that in 5 days was ambitious and tiring. It just stresses the importance for you to go home and do some extra reading before you go into that specialty placement as a 1 hour lecture is not going to cover enough for you to get through the placement. Because of this, I spent my weekend reading up on Anaesthetics and Critical Care. In a way I am really excited for this attachment as I am placed in the main hospital and it is quite busy so I know I will be able to get a lot of hands-on experience instead of swivelling in my chair. I also spent the weekend trying to get as much sleep as I can (12 hours today!) as I'm starting at 8 am every day. I felt a bit of me cry, but at the same time if it's a good attachment I don't see waking up being an issue.
Hmmm....to be honest there isn't much to talk about from this week as it was really dull and I won't bore you with the details. Hopefully next week will be action-packed and hopefully can give you all a more exciting read!
To give you an idea what sort of lectures we had this week - we went through topics in Urology, Opthamology, Haematology, Anaesthetics, Dermatology, Trauma, Oncology, Infectious Diseases, and ENT. To be fair, covering all of that in 5 days was ambitious and tiring. It just stresses the importance for you to go home and do some extra reading before you go into that specialty placement as a 1 hour lecture is not going to cover enough for you to get through the placement. Because of this, I spent my weekend reading up on Anaesthetics and Critical Care. In a way I am really excited for this attachment as I am placed in the main hospital and it is quite busy so I know I will be able to get a lot of hands-on experience instead of swivelling in my chair. I also spent the weekend trying to get as much sleep as I can (12 hours today!) as I'm starting at 8 am every day. I felt a bit of me cry, but at the same time if it's a good attachment I don't see waking up being an issue.
Hmmm....to be honest there isn't much to talk about from this week as it was really dull and I won't bore you with the details. Hopefully next week will be action-packed and hopefully can give you all a more exciting read!
Sunday, July 8, 2012
A Mask.
This isn't a new revelation, but one that has occurred to me more during my GP placement.
I have come to realize that doctors need to put on a mask most of the time as patients come to doctors for various kinds of problems. No matter how annoyed you are about a patient or how fed up you are with your clinic, you cannot let it show. There are tons of patients out there who visit the GP 2-4x a month and I'm sure as the GP you can get frustrated/annoyed with the patient especially when they are coming in for insignificant things. It is definitely difficult as patients expect the doctor to be professional and empathetic, but it is extremely difficult to show this when the patient themselves aren't coming in with the right intentions. I have sat in clinics where the patient is very rude and overly demanding. And as a doctor, you can't do anything about their rudeness, other than still treat them respectfully and try your best to listen. Definitely need a high tolerance level when dealing with "troublesome" patients. On the contrary, there are certainly very nice patients (usually tend to be the elderly). They are usually very respectful and always apologizing about wasting your time. These are the patients who are worth treating and you can't help but be a bit more empathetic, despite knowing that you're supposed to treat all patients with empathy and care.
However, masks are not just for GPs. As I have mentioned earlier, I have encountered it in my other placements. You would think surgeons wouldn't need to put on a mask as often, as they have a bit less patient contact. Unfortunately, surgeons have just as much face time with patients; however, the reasons of putting on a mask may be different. After a surgery and you have to break some bad news/complications about the surgery, you have to be able to put on a confident face and an appropriate mask. There isn't as much time for you to gather yourself after the operation. GPs or physicians in general would get results/bad news ahead of time so they will be ready and have time to think about how they will break the news. It is definitely a tough job as you don't want to show that much emotion when talking to patients especially after a tough case/surgery.
With clinics, you could enjoy the company of one of the patients and be laughing about something, but you have to be able to quickly return back to neutral before seeing your next patient. It can work the other way around as for one particular case, we were giving our condolences to a patient as her father had just passed away the day before and she was telling us about his death. Definitely an emotional/sad moment where you have to again put on a mask and empathize and comfort the patient. Easily within 2 minutes between patients, you have to regain your composure and be ready for the next patient as he or she can come in with anything. You certainly can't let things affect you and as well for doctors, you have to be good with moving on. You can't dwell on one particular case.
There has been arguments that doctors should not bring their outside emotions to work. Despite having a horrible morning, people argue that you shouldn't bring that grumpiness into the work place. I personally agree with that point as it isn't fair to your patients and your colleagues. I have met a few GPs who said that it is important to bring your emotions to work as you will seem more genuine. I don't mind bringing in a good mood to work, but I certainly wouldn't want to bring in grumpiness to the work place as you can easily affect your patients and colleagues. No one wants to see a grumpy doctor. In my eyes, I think my emotions should not affect my work, so even in that sense, you will have to put on a mask before coming to work especially when you're having a bad day. People argue as a doctor you should be genuine, but for me it is far more advantageous if I put on a mask for work and sort out my issues/problems when I go home/leave work.
What are your thoughts about putting on a mask for work or bringing your emotions to work?
Post your comments below!
I have come to realize that doctors need to put on a mask most of the time as patients come to doctors for various kinds of problems. No matter how annoyed you are about a patient or how fed up you are with your clinic, you cannot let it show. There are tons of patients out there who visit the GP 2-4x a month and I'm sure as the GP you can get frustrated/annoyed with the patient especially when they are coming in for insignificant things. It is definitely difficult as patients expect the doctor to be professional and empathetic, but it is extremely difficult to show this when the patient themselves aren't coming in with the right intentions. I have sat in clinics where the patient is very rude and overly demanding. And as a doctor, you can't do anything about their rudeness, other than still treat them respectfully and try your best to listen. Definitely need a high tolerance level when dealing with "troublesome" patients. On the contrary, there are certainly very nice patients (usually tend to be the elderly). They are usually very respectful and always apologizing about wasting your time. These are the patients who are worth treating and you can't help but be a bit more empathetic, despite knowing that you're supposed to treat all patients with empathy and care.
However, masks are not just for GPs. As I have mentioned earlier, I have encountered it in my other placements. You would think surgeons wouldn't need to put on a mask as often, as they have a bit less patient contact. Unfortunately, surgeons have just as much face time with patients; however, the reasons of putting on a mask may be different. After a surgery and you have to break some bad news/complications about the surgery, you have to be able to put on a confident face and an appropriate mask. There isn't as much time for you to gather yourself after the operation. GPs or physicians in general would get results/bad news ahead of time so they will be ready and have time to think about how they will break the news. It is definitely a tough job as you don't want to show that much emotion when talking to patients especially after a tough case/surgery.
With clinics, you could enjoy the company of one of the patients and be laughing about something, but you have to be able to quickly return back to neutral before seeing your next patient. It can work the other way around as for one particular case, we were giving our condolences to a patient as her father had just passed away the day before and she was telling us about his death. Definitely an emotional/sad moment where you have to again put on a mask and empathize and comfort the patient. Easily within 2 minutes between patients, you have to regain your composure and be ready for the next patient as he or she can come in with anything. You certainly can't let things affect you and as well for doctors, you have to be good with moving on. You can't dwell on one particular case.
There has been arguments that doctors should not bring their outside emotions to work. Despite having a horrible morning, people argue that you shouldn't bring that grumpiness into the work place. I personally agree with that point as it isn't fair to your patients and your colleagues. I have met a few GPs who said that it is important to bring your emotions to work as you will seem more genuine. I don't mind bringing in a good mood to work, but I certainly wouldn't want to bring in grumpiness to the work place as you can easily affect your patients and colleagues. No one wants to see a grumpy doctor. In my eyes, I think my emotions should not affect my work, so even in that sense, you will have to put on a mask before coming to work especially when you're having a bad day. People argue as a doctor you should be genuine, but for me it is far more advantageous if I put on a mask for work and sort out my issues/problems when I go home/leave work.
What are your thoughts about putting on a mask for work or bringing your emotions to work?
Post your comments below!
Tuesday, June 19, 2012
Theatre Etiquette.
As promised I will discuss about surgical theatre etiquette. Theatre is a really good way to see anatomy and learn more about the management of certain conditions. Again like the wards it's a really daunting place to be in. I actually found theatre a bit of a scary place as there's so much equipment in there, but once you have experienced it...it really isn't that bad. Your consultant finally invites you to go to theatre with him next day so here are some tips: Find the theatre list for the day you'll be going into theatre so you can get an idea what you'll be seeing - best place to go is the consultant's secretary. This will allow you to do a bit of reading up on relevant anatomy for the surgery. Also a great chance to read up on the condition that the surgery is treating. Most consultants like to ask questions during surgery so make sure you're ready. Nothing worse than being the student that seems like he/she didn't do any preparation whatsoever. Also theatre starts at different times so it is something you'll have to find out from the consultant/registrar/theatre staff/secretary. Make sure you turn up for the very beginning as this is when everyone introduces each other and go through a team briefing. So you get to the hospital - what do you do next?
Head on to theatre and sign in. Go get changed into scrubs and put on a theatre cap. Make sure you also change into theatre shoes which are usually clogs/the super fashionable crocs. Hopefully your hospital have some theatre shoes for you to borrow so make sure you ask at reception first. Take off all jewelery. At all times make sure your ID is visible. In general for theatre changing rooms it is best to bring your valuables with you or simply don't bring valuables to a theatre day. I always bring my money and my phone with me and depending on the hospital I also bring my bag with me to theatre as it's just a small messenger bag. Make sure you leave the bag in the prep room or ask theatre staff where you can put your bag.
So you get to the theatre and hopefully you'll know who is the consultant. Go introduce yourself or say "Hi". You'll be surprised how often they don't notice you even though you think they saw you. I guess sometimes they can't recognize you as you are in scrubs and have a theatre cap on. Get in on the team briefing and pay attention to the theatre list for the day. Also find out who is the anaesthetist. Ask the anaesthetist if you can observe the patient being put to sleep. It's quite interesting to watch.
Simple rules of theatre:
If it is a laparoscopic surgery - there will be a tv screen for you to watch so you don't need to be standing as close to the surgeons. Just find a good spot to stand and for me, I never sit down as I think the theatre staff are more deserving of a chair than I am.
The problem with surgeries is that it can range from 30 minutes to 8 hours. You'll find that your back and feet will be hating you during long surgeries. Also make sure when you're standing for a long time just to keep your legs moving so you don't faint. Sometimes with long procedures I will go take a walk around the operating room just to get my legs moving again and give my back a stretch. No matter how much you love surgery (and take it from me - I really do LOVE surgery) - it will get boring especially when you're not scrubbed in and just observing. If nothing interesting is happening go talk to the anaesthetist. Ask he/she about the machines and what they are doing. The thing with surgeries as well is finding the right time to ask questions. There will be times where the room goes dead quiet as the surgeons are concentrating - obviously horrible time to ask a question. You'll be able to tell when they don't need to focus as much as usually they'll start talking about really random things like plans for the weekend...you'll be surprised what sort of things surgeons talk about during surgery. Some surgeons even have music playing in the background so don't be shocked when you walk in and there is music playing. I think the best one was when I was waiting outside a day surgery theatre and the doors to the operating room opened and all you can hear was music blasting out...almost seemed like a night club in there!
Hopefully your consultant will be good at teaching and he'll show you the relevant anatomy IF it is easy to see. Not all the time the anatomy is easy to see, but don't be disappointed if you don't really see much. Most surgeries that I have observed - I usually don't see very much so don't think this is your fault. Especially now, surgeons are trying to make incisions smaller to reduce the recovery time...but again as long as your consultant knows he/she has a student around - most are quite good at moving over and letting you do a quick lean in to take a closer look - again make sure you don't touch the patient/surgeons.
When the surgery is done - go make yourself useful and help the theatre staff with moving the patient. Put on a pair of non-sterile gloves and grab hold of one side of the bed sheets (other than the head as the anaesthetist will be there). It'll be made clear which way the patient will be going and usually the clue is probably the empty bed right next to the operating bed with a slide board underneath. The anaesthetist will always count you down to moving so some will say "On 3" or "Ready Steady *Move/Shift*" - either way it'll be obvious.
If the previous surgery was long - you might want to stick yourself onto the consultant/registrar as they usually will disappear to the coffee room. Go make yourself a drink or get some water - staying hydrated is key for surgery. Sometimes it is quite frustrating as you could wait for an hour before the next surgery. I always hate coffee room breaks - not because I hate waiting around...it's because sometimes the consultant needs to quickly pop up to the ward and you're left alone in the coffee room. Just keep your eye on someone who is from your theatre as they tend to leave without telling you. Well based on personal experience - I always get left behind so I always got to stay near the registrar/consultant/theatre staff just so I wont miss the next surgery. Another way is before breaking off to the coffee room - ask a theatre staff how long a break do you have or what time does the next surgery start - then at least if you lose everyone - you'll still know what time to get back.
Hopefully this gives you a better idea what to expect when going to theatre for the first time. Hey maybe you'll be lucky and get to scrub in. But don't be disheartened if you don't scrub in as I didn't get to scrub in til this year (3rd year of medical school - been on surgical placements ever since 1st year). So just enjoy your time in theatre and hopefully you'll see lots of cool things. Also a great place to witness some good teamwork and communication skills as well. If you're unsure about anything just ask a theatre staff.
Head on to theatre and sign in. Go get changed into scrubs and put on a theatre cap. Make sure you also change into theatre shoes which are usually clogs/the super fashionable crocs. Hopefully your hospital have some theatre shoes for you to borrow so make sure you ask at reception first. Take off all jewelery. At all times make sure your ID is visible. In general for theatre changing rooms it is best to bring your valuables with you or simply don't bring valuables to a theatre day. I always bring my money and my phone with me and depending on the hospital I also bring my bag with me to theatre as it's just a small messenger bag. Make sure you leave the bag in the prep room or ask theatre staff where you can put your bag.
So you get to the theatre and hopefully you'll know who is the consultant. Go introduce yourself or say "Hi". You'll be surprised how often they don't notice you even though you think they saw you. I guess sometimes they can't recognize you as you are in scrubs and have a theatre cap on. Get in on the team briefing and pay attention to the theatre list for the day. Also find out who is the anaesthetist. Ask the anaesthetist if you can observe the patient being put to sleep. It's quite interesting to watch.
Simple rules of theatre:
- Don't touch anything green/blue in the operating room especially on tables/trolleys
- If you're going to faint - don't faint on the patient - so go sit down - it happens to everyone
- When the surgeons are gowned up - don't make any contact with them as they are now sterile so that means good dodging skills and just stay out of their way until they have gotten to their place at the table
If it is a laparoscopic surgery - there will be a tv screen for you to watch so you don't need to be standing as close to the surgeons. Just find a good spot to stand and for me, I never sit down as I think the theatre staff are more deserving of a chair than I am.
The problem with surgeries is that it can range from 30 minutes to 8 hours. You'll find that your back and feet will be hating you during long surgeries. Also make sure when you're standing for a long time just to keep your legs moving so you don't faint. Sometimes with long procedures I will go take a walk around the operating room just to get my legs moving again and give my back a stretch. No matter how much you love surgery (and take it from me - I really do LOVE surgery) - it will get boring especially when you're not scrubbed in and just observing. If nothing interesting is happening go talk to the anaesthetist. Ask he/she about the machines and what they are doing. The thing with surgeries as well is finding the right time to ask questions. There will be times where the room goes dead quiet as the surgeons are concentrating - obviously horrible time to ask a question. You'll be able to tell when they don't need to focus as much as usually they'll start talking about really random things like plans for the weekend...you'll be surprised what sort of things surgeons talk about during surgery. Some surgeons even have music playing in the background so don't be shocked when you walk in and there is music playing. I think the best one was when I was waiting outside a day surgery theatre and the doors to the operating room opened and all you can hear was music blasting out...almost seemed like a night club in there!
Hopefully your consultant will be good at teaching and he'll show you the relevant anatomy IF it is easy to see. Not all the time the anatomy is easy to see, but don't be disappointed if you don't really see much. Most surgeries that I have observed - I usually don't see very much so don't think this is your fault. Especially now, surgeons are trying to make incisions smaller to reduce the recovery time...but again as long as your consultant knows he/she has a student around - most are quite good at moving over and letting you do a quick lean in to take a closer look - again make sure you don't touch the patient/surgeons.
When the surgery is done - go make yourself useful and help the theatre staff with moving the patient. Put on a pair of non-sterile gloves and grab hold of one side of the bed sheets (other than the head as the anaesthetist will be there). It'll be made clear which way the patient will be going and usually the clue is probably the empty bed right next to the operating bed with a slide board underneath. The anaesthetist will always count you down to moving so some will say "On 3" or "Ready Steady *Move/Shift*" - either way it'll be obvious.
If the previous surgery was long - you might want to stick yourself onto the consultant/registrar as they usually will disappear to the coffee room. Go make yourself a drink or get some water - staying hydrated is key for surgery. Sometimes it is quite frustrating as you could wait for an hour before the next surgery. I always hate coffee room breaks - not because I hate waiting around...it's because sometimes the consultant needs to quickly pop up to the ward and you're left alone in the coffee room. Just keep your eye on someone who is from your theatre as they tend to leave without telling you. Well based on personal experience - I always get left behind so I always got to stay near the registrar/consultant/theatre staff just so I wont miss the next surgery. Another way is before breaking off to the coffee room - ask a theatre staff how long a break do you have or what time does the next surgery start - then at least if you lose everyone - you'll still know what time to get back.
Hopefully this gives you a better idea what to expect when going to theatre for the first time. Hey maybe you'll be lucky and get to scrub in. But don't be disheartened if you don't scrub in as I didn't get to scrub in til this year (3rd year of medical school - been on surgical placements ever since 1st year). So just enjoy your time in theatre and hopefully you'll see lots of cool things. Also a great place to witness some good teamwork and communication skills as well. If you're unsure about anything just ask a theatre staff.
Friday, June 8, 2012
The End of Another Placement.
Seriously cannot believe it has been 6 weeks. It literally blew by. I didn't think it would as I wasn't particularly busy and I had quite a few day offs as well (bank holidays, etc). My friends said that you cannot find a happier medical student on placement than me. I will admit, the placement started off quite slow...but once it got going...I truly truly truly did not want it to end. It's the first specialty where I could see myself work in as a career. Before starting, I was a bit hesitant as ever since I knew I wanted to do medicine, I wanted to do orthopaedics. I had very high hopes for it. Obviously I was very excited to start the placement, but there was a bit of doubt in the back of my mind. These 6 weeks could either make or break this specialty for me. I was actually scared that I will end up not liking orthopaedics...and actually hating it.
Luckily, orthopaedic surgery is just like how I imagined it to be. I was genuinely happy. It's the first placement where I enjoyed everything about the specialty. I enjoyed the surgeries. I enjoyed being on the ward (which was minimal to be fair). And I can't believe I am saying this but I enjoyed clinic. Everything clicked for me. I never struggled waking up to go to this placement. I had 8am meetings to go to (where I had to wake up at 6am) and I never struggled. If this was any other specialty and was told to go to an 8am meeting...I can guarantee you I would struggle and would probably turn up late or maybe even miss it. I was actually motivated to work hard in this placement. I didn't work hard because my supervisor was strict/I was scared of him...I actually worked hard because I enjoyed the specialty. I felt no pressure to work hard...actually my supervisor kept telling me to take it easy and made it very free. It was all down to me. There were times where I wished I was in more.
This was probably the most flexible and easy going placement I have had this year, but this is easily the one placement where I have learned the most. I had lots of fun, but also learned a lot of useful things. I am so lucky to have a supervisor who is really good with teaching and letting me progress. You all probably remember me having great praises for my last O&G placement and that it has set a very high bar. This orthopaedic placement just blew through that bar. I mean I knew it was going to be hard to have more fun and more responsibilities than my last placement, but wow this placement was fantastic. I have nothing but good things to say. I got to scrub in. I assisted in surgery. I learned how to suture and help close up. I saw patients in clinic on my own and got to examine them. I got to start and finish an audit project. I really could not ask for more. I don't even think I could do much more.
Today started out like any other day. Early meeting and then to morning clinic. Usual banter in the meeting...lots of good laughs and teasing. I took up my usual spot at the back of the room against the cabinet. Then off to clinic. Busy clinic as usual. Saw new patients on my own. Did the usual. I'm sure no one knew it was my last day because everything was going like it was just another day of my placement. Patient by patient...the note pile got smaller and smaller. Clinic was coming to an end. Next thing I knew my supervisor was signing my feedback form off. Had a bit of a chat about the placement and then a solid handshake. To be honest it was tough to leave. I wasn't sick of the placement yet. Just wasn't ready for it to end already. Every day when we finish and before I leave, I always crack a: "When am I seeing you next?" It was weird not to say that as I was heading for the door. I didn't even know what to say as I left. I think all I kept saying was "thank you" as I dragged my feet out the door. Even now...I'm absolutely gutted this placement is over. Feels like someone shot me out from cloud 9. Next week is going to be tough. Back to lectures. Back to reality. Then on to GP and being cooped up in a clinic from 9-5. No surgeries. Not in a hospital environment. Going to be out of my element. Hurts just to think about it. Should be a crime to enjoy a placement so much. Genuinely loved this placement. Entered placement as one of the happiest medical student you can find to probably the most gutted one at the moment. What a contrast. Just shows you how much I enjoyed this placement.
Luckily, orthopaedic surgery is just like how I imagined it to be. I was genuinely happy. It's the first placement where I enjoyed everything about the specialty. I enjoyed the surgeries. I enjoyed being on the ward (which was minimal to be fair). And I can't believe I am saying this but I enjoyed clinic. Everything clicked for me. I never struggled waking up to go to this placement. I had 8am meetings to go to (where I had to wake up at 6am) and I never struggled. If this was any other specialty and was told to go to an 8am meeting...I can guarantee you I would struggle and would probably turn up late or maybe even miss it. I was actually motivated to work hard in this placement. I didn't work hard because my supervisor was strict/I was scared of him...I actually worked hard because I enjoyed the specialty. I felt no pressure to work hard...actually my supervisor kept telling me to take it easy and made it very free. It was all down to me. There were times where I wished I was in more.
This was probably the most flexible and easy going placement I have had this year, but this is easily the one placement where I have learned the most. I had lots of fun, but also learned a lot of useful things. I am so lucky to have a supervisor who is really good with teaching and letting me progress. You all probably remember me having great praises for my last O&G placement and that it has set a very high bar. This orthopaedic placement just blew through that bar. I mean I knew it was going to be hard to have more fun and more responsibilities than my last placement, but wow this placement was fantastic. I have nothing but good things to say. I got to scrub in. I assisted in surgery. I learned how to suture and help close up. I saw patients in clinic on my own and got to examine them. I got to start and finish an audit project. I really could not ask for more. I don't even think I could do much more.
Today started out like any other day. Early meeting and then to morning clinic. Usual banter in the meeting...lots of good laughs and teasing. I took up my usual spot at the back of the room against the cabinet. Then off to clinic. Busy clinic as usual. Saw new patients on my own. Did the usual. I'm sure no one knew it was my last day because everything was going like it was just another day of my placement. Patient by patient...the note pile got smaller and smaller. Clinic was coming to an end. Next thing I knew my supervisor was signing my feedback form off. Had a bit of a chat about the placement and then a solid handshake. To be honest it was tough to leave. I wasn't sick of the placement yet. Just wasn't ready for it to end already. Every day when we finish and before I leave, I always crack a: "When am I seeing you next?" It was weird not to say that as I was heading for the door. I didn't even know what to say as I left. I think all I kept saying was "thank you" as I dragged my feet out the door. Even now...I'm absolutely gutted this placement is over. Feels like someone shot me out from cloud 9. Next week is going to be tough. Back to lectures. Back to reality. Then on to GP and being cooped up in a clinic from 9-5. No surgeries. Not in a hospital environment. Going to be out of my element. Hurts just to think about it. Should be a crime to enjoy a placement so much. Genuinely loved this placement. Entered placement as one of the happiest medical student you can find to probably the most gutted one at the moment. What a contrast. Just shows you how much I enjoyed this placement.
Saturday, June 2, 2012
Post #100 - A Look Back.
Post #100 for this blog. I obviously want to make a special post and let's take a trip back to the beginning of this blog.
August 6, 2009 - my first blog post. It was a big day for me as it was the day I received an unconditional offer from my university to study Medicine in the UK. Looking back, coming to study in the UK was a huge decision and definitely a path of a lot of unknowns. A new country. A new culture. A new chapter. Little did I know what a roller coaster ride it would be for the next 2.5 years. I faced many challenges (and still facing challenges) and have grown up a lot in the last 2.5 years. University was a new chapter to my life. Saw and learned so many new things. It has so far been the best few years of my life. I can easily say that Freshers week will always be a highlight as it was quite an experience getting to know so many new people in such a short amount of time. I've been in the same school for half my life so making new friends is something "new" and I was extremely nervous. Kind of laughing at myself now for being so nervous/scared as there was nothing to be scared about. Every one is on the same boat in terms of friends and people are just so friendly. A tip for those who will be starting this coming September: be EXCITED. There is nothing to be afraid of and don't let anything hold you back. Enjoy your time as a Fresher as it will blow by in a blink of an eye.
When I first started this blog I was really unsure whether I will even be able to keep up with it. Slowly I've noticed that people are reading it and it really motivated me to keep posting. Whilst scrolling through my archives...I have noticed quite a change in frequency of posts. I think it's a fairly good representation of excitement through my years in medical school. Obviously if there is something exciting, I would post about it. Here's reality: the first 2 years of medical school is a bit of a shock. I think a lot of us come into medical school thinking like we would be like the TV show ER...or House and we would be immersed in doing clinical procedures and running around. WRONG. Well in my case I was stuck in a lecture theatre for 2 years learning about the basic sciences, which isn't the most exciting thing. It is obvious there were a lot of up and downs in the last 2 years. I lost sight of the final prize (becoming a doctor) several times throughout the last 2 years. You get to a certain point where you're like "get me on the wards!" and then there will be times where you ask yourself: "Why in the world am I studying Medicine?" Medical school is full of obstacles and it is emotionally, mentally, and physically tough. There are so many times where you're on the floor and you really need to dig deep to pick yourself back up. I realized this is a degree that you have to be committed to because there are times where you truly do question your desires of being a doctor. Then at last - I reached clinical years. 2 grueling years of being cooped up in a lecture theatre and finally I am able to do some practical things and talk to patients. But hold up...with my school we are quite lucky to have a bit of clinical experience in the first 2 years.
March 15, 2010 - first hospital attachment. It was a short clinical attachment and really just a taste test of what I'll be doing in the future. Only a few months ago I saw first year medical students starting with their first clinical attachment like I did back in 2010. Seeing these freshers really put things into perspective of how far you have come along. (And for once it was nice not being at the bottom of the ladder at the hospital). It really gave me a flashback to what it was like when I started my first clinical attachment. Patient histories were a struggle...I was not good at them at all. Hardly knew any medical sciences so I didn't really understand anything and tried my best to keep up. Couldn't do any clinical skills. Essentially just shadowed the doctors and tried to not get in the way. Went to observe a few surgeries and standing on a pedestal trying to peer over the consultant's shoulder. However, I do remember how much I enjoyed watching surgeries. It just clicked. Fast forward to 2012. Patient histories - easy. Interacting with patients - easy. Medical knowledge - growing every day. Clinical skills - taking bloods, inserting cannulas, inserting catheters...just the other day I put in an endotracheal tube on my own (supervised by the anaesthetist). Surgery - observe? Heck I'm scrubbing in now and even helping close up at the end! Medical school is a long and painful process...but when you take the time to stop and think back to when you started...you see how far you have come.
February 8, 2011 - immigration laws changing. I believe this is the first proper post where I've discussed in detail about being an international student and things we have to think about. From then on, I have dedicated 2 other posts (Tidbit for International Students and Life of an International Student) to give a bit more insight about the life of an INTERNATIONAL medical student. To be honest, being an international student isn't that much more different than a local British student. We go through the same course. We get treated the same. We learn the same things. We see the same things. The only difference is our accents, and our passports...and the fact we have to worry about Visas and immigration laws. But other than that, being an international student hasn't been that hard of a transition that I had initially thought. Before I started medical school, my biggest fear was the fact I was an international student and it might be a bit harder for me to make friends or get used to the culture. Again during Freshers week...everyone was just so friendly...I didn't feel different. I didn't feel that much of an outsider. There were a few times in the last 2.5 years where it was frustrating to be an international student due to the lack of support from the medical school, but you learn to manage. As an international student, you make a lot of sacrifice. You leave your family behind. You leave home behind (which can be thousands of miles away). You pay higher fees. But hey hopefully it will be worth it. Hopefully this is something I will not regret. At the end of the day...hopefully this will be all worth it. Homesickness is a huge thing for international students and a lot of my friends do struggle with this...including me. Every time this happens I just have to take a break and tell myself it will be worth it and think about all the obstacles I have already been through and how far I have come. What makes me wake up every morning is the end prospect from studying medicine. I am grateful to be in such a great field and the experiences I have had so far have been amazing. The future with immigration and working in the UK - not a straight path and one with many bumps, but the fact I have made so many sacrifices just gives me so much more motivation and determination to make it work. Work hard and hopefully have a bit of luck on my side when it comes to jobs.
August 7, 2009 - first tip post. Not exactly one of my best tip post, but hey we all got to start somewhere. Obviously this blog was to keep a track of my crazy life of being a medical student, but also to give some tips to future medical applicants. I try my best and over the last 2 years I have posted quite a few tip posts here and there. Applying to medical school is no easy process and I wished I got some tips. My school back in Canada was not very good with helping out students with applying abroad as they are not very familiar with the process. It was a difficult process as I had to do a lot of stuff myself and call up universities in the middle of the night (my time due to the time difference) to get some more information. Hopefully with my tip posts I am able to help future applicants with the process. Obviously I applied 3ish years ago so UKCAT info and tips are a bit off, but I'm sure the interview process is still the same. Now I'm trying to focus on giving tips on surviving medical school. Little tricks I have learned here and there. I remember my very first medical school lecture, one of my professors told all of us: "Life is not fair." And it is so true and particularly true with medical school. So here is a tip to all of you: Life is not fair. You cannot have your way with everything...unfortunately, BUT what you can do is make the best of every experience no matter how undesirable it is. There is always something to learn. Stay humble and treat those around you with the same respect you would expect in return. You will meet a lot of people throughout medical school and treat everyone well as you never know, you might see he or she again in the future. Consultants on placements - treat them with as much respect as you can as who knows, he or she may just be your future employer in a few years. Don't do anything you will regret, even outside of school hours as things can come back and bite you on the ass. Unfortunately as a medical student - we got to grow up very fast. We start medical school at around 18 or 19 years old...you will see patients of all ages and they expect professional behaviour despite your age. Also grow some thick skin - consultants can be very unforgiving. Do your best to not take it personal. At the end of the day their criticisms are for your own good.
June 2, 2012 - post #100. It has been quite a journey and I expect more ups and downs in the next 2 years. Being a doctor is starting to get real. Now going through my specialty placements, I'm starting to do more and more on placements. This post has made me look back and realize how much I have grown emotionally and mentally. Thank you to all you readers out there and keeping me going on this blog. I really appreciate it. Happy reading!
August 6, 2009 - my first blog post. It was a big day for me as it was the day I received an unconditional offer from my university to study Medicine in the UK. Looking back, coming to study in the UK was a huge decision and definitely a path of a lot of unknowns. A new country. A new culture. A new chapter. Little did I know what a roller coaster ride it would be for the next 2.5 years. I faced many challenges (and still facing challenges) and have grown up a lot in the last 2.5 years. University was a new chapter to my life. Saw and learned so many new things. It has so far been the best few years of my life. I can easily say that Freshers week will always be a highlight as it was quite an experience getting to know so many new people in such a short amount of time. I've been in the same school for half my life so making new friends is something "new" and I was extremely nervous. Kind of laughing at myself now for being so nervous/scared as there was nothing to be scared about. Every one is on the same boat in terms of friends and people are just so friendly. A tip for those who will be starting this coming September: be EXCITED. There is nothing to be afraid of and don't let anything hold you back. Enjoy your time as a Fresher as it will blow by in a blink of an eye.
When I first started this blog I was really unsure whether I will even be able to keep up with it. Slowly I've noticed that people are reading it and it really motivated me to keep posting. Whilst scrolling through my archives...I have noticed quite a change in frequency of posts. I think it's a fairly good representation of excitement through my years in medical school. Obviously if there is something exciting, I would post about it. Here's reality: the first 2 years of medical school is a bit of a shock. I think a lot of us come into medical school thinking like we would be like the TV show ER...or House and we would be immersed in doing clinical procedures and running around. WRONG. Well in my case I was stuck in a lecture theatre for 2 years learning about the basic sciences, which isn't the most exciting thing. It is obvious there were a lot of up and downs in the last 2 years. I lost sight of the final prize (becoming a doctor) several times throughout the last 2 years. You get to a certain point where you're like "get me on the wards!" and then there will be times where you ask yourself: "Why in the world am I studying Medicine?" Medical school is full of obstacles and it is emotionally, mentally, and physically tough. There are so many times where you're on the floor and you really need to dig deep to pick yourself back up. I realized this is a degree that you have to be committed to because there are times where you truly do question your desires of being a doctor. Then at last - I reached clinical years. 2 grueling years of being cooped up in a lecture theatre and finally I am able to do some practical things and talk to patients. But hold up...with my school we are quite lucky to have a bit of clinical experience in the first 2 years.
March 15, 2010 - first hospital attachment. It was a short clinical attachment and really just a taste test of what I'll be doing in the future. Only a few months ago I saw first year medical students starting with their first clinical attachment like I did back in 2010. Seeing these freshers really put things into perspective of how far you have come along. (And for once it was nice not being at the bottom of the ladder at the hospital). It really gave me a flashback to what it was like when I started my first clinical attachment. Patient histories were a struggle...I was not good at them at all. Hardly knew any medical sciences so I didn't really understand anything and tried my best to keep up. Couldn't do any clinical skills. Essentially just shadowed the doctors and tried to not get in the way. Went to observe a few surgeries and standing on a pedestal trying to peer over the consultant's shoulder. However, I do remember how much I enjoyed watching surgeries. It just clicked. Fast forward to 2012. Patient histories - easy. Interacting with patients - easy. Medical knowledge - growing every day. Clinical skills - taking bloods, inserting cannulas, inserting catheters...just the other day I put in an endotracheal tube on my own (supervised by the anaesthetist). Surgery - observe? Heck I'm scrubbing in now and even helping close up at the end! Medical school is a long and painful process...but when you take the time to stop and think back to when you started...you see how far you have come.
February 8, 2011 - immigration laws changing. I believe this is the first proper post where I've discussed in detail about being an international student and things we have to think about. From then on, I have dedicated 2 other posts (Tidbit for International Students and Life of an International Student) to give a bit more insight about the life of an INTERNATIONAL medical student. To be honest, being an international student isn't that much more different than a local British student. We go through the same course. We get treated the same. We learn the same things. We see the same things. The only difference is our accents, and our passports...and the fact we have to worry about Visas and immigration laws. But other than that, being an international student hasn't been that hard of a transition that I had initially thought. Before I started medical school, my biggest fear was the fact I was an international student and it might be a bit harder for me to make friends or get used to the culture. Again during Freshers week...everyone was just so friendly...I didn't feel different. I didn't feel that much of an outsider. There were a few times in the last 2.5 years where it was frustrating to be an international student due to the lack of support from the medical school, but you learn to manage. As an international student, you make a lot of sacrifice. You leave your family behind. You leave home behind (which can be thousands of miles away). You pay higher fees. But hey hopefully it will be worth it. Hopefully this is something I will not regret. At the end of the day...hopefully this will be all worth it. Homesickness is a huge thing for international students and a lot of my friends do struggle with this...including me. Every time this happens I just have to take a break and tell myself it will be worth it and think about all the obstacles I have already been through and how far I have come. What makes me wake up every morning is the end prospect from studying medicine. I am grateful to be in such a great field and the experiences I have had so far have been amazing. The future with immigration and working in the UK - not a straight path and one with many bumps, but the fact I have made so many sacrifices just gives me so much more motivation and determination to make it work. Work hard and hopefully have a bit of luck on my side when it comes to jobs.
August 7, 2009 - first tip post. Not exactly one of my best tip post, but hey we all got to start somewhere. Obviously this blog was to keep a track of my crazy life of being a medical student, but also to give some tips to future medical applicants. I try my best and over the last 2 years I have posted quite a few tip posts here and there. Applying to medical school is no easy process and I wished I got some tips. My school back in Canada was not very good with helping out students with applying abroad as they are not very familiar with the process. It was a difficult process as I had to do a lot of stuff myself and call up universities in the middle of the night (my time due to the time difference) to get some more information. Hopefully with my tip posts I am able to help future applicants with the process. Obviously I applied 3ish years ago so UKCAT info and tips are a bit off, but I'm sure the interview process is still the same. Now I'm trying to focus on giving tips on surviving medical school. Little tricks I have learned here and there. I remember my very first medical school lecture, one of my professors told all of us: "Life is not fair." And it is so true and particularly true with medical school. So here is a tip to all of you: Life is not fair. You cannot have your way with everything...unfortunately, BUT what you can do is make the best of every experience no matter how undesirable it is. There is always something to learn. Stay humble and treat those around you with the same respect you would expect in return. You will meet a lot of people throughout medical school and treat everyone well as you never know, you might see he or she again in the future. Consultants on placements - treat them with as much respect as you can as who knows, he or she may just be your future employer in a few years. Don't do anything you will regret, even outside of school hours as things can come back and bite you on the ass. Unfortunately as a medical student - we got to grow up very fast. We start medical school at around 18 or 19 years old...you will see patients of all ages and they expect professional behaviour despite your age. Also grow some thick skin - consultants can be very unforgiving. Do your best to not take it personal. At the end of the day their criticisms are for your own good.
June 2, 2012 - post #100. It has been quite a journey and I expect more ups and downs in the next 2 years. Being a doctor is starting to get real. Now going through my specialty placements, I'm starting to do more and more on placements. This post has made me look back and realize how much I have grown emotionally and mentally. Thank you to all you readers out there and keeping me going on this blog. I really appreciate it. Happy reading!
Thursday, May 31, 2012
What a Day.
So like I said in my last post, my placement is coming to an end and because my supervisor is really good with slowly giving me more responsibilities as the weeks go by, this week has been a lot of fun. My last placement, Obs and Gynae, could easily be the highlight of my medical school in terms of all-round great placement. Yesterday could have EASILY been the highlight day of my degree so far and by the looks of it - this placement will probably become the best placement of my degree.
Anyways yesterday was theatre day and was expecting to have 3 patients on the theatre list but I was actually disappointed in the morning to find out that one of the patients were cancelled so we only had two patients on the list. It was also going to be my last orthopaedic theatre list for this placement so I was a bit bummed out that we were most likely going to finish early. First patient was a simple straight forward one man job so I didn't scrub in and just observed. Afterwards we had a good break prior to the next and final patient for the day. Had some good banter with my supervisor and then I went to go see the patient in the anaesthetic room. It was a bit weird as the anaesthetist had quite a bit of difficulty putting in an epidural and other things just weren't going right/straight forward. The anaesthetist and I had a bit of a chat and we agreed that we have a feeling this surgery is going to be FAR from straightforward. Anyways after the patient was put to sleep my supervisor came in and told me that I will be scrubbing in and will be a first assistant. My eyes lit up. Last few weeks, I was scrubbed in, but I was more of an observer who did a bit of suction here and there, but nothing really special/that helpful.
Brief summary of patient: 1st stage revision of total hip replacement. Reason: Infection
11.10 - first incision made
I am still a bit new to orthopaedic surgery, but I have seen a few now and I knew immediately that something wasn't right. Immediately after the first incision, the patient was bleeding a lot more than usual. As we went deeper, it was obvious that the bleeding is only going to get worse and by the time we got to the muscle layers...it was like the flood gates were opened. The patient was bleeding from all sides of the opening and it was difficult to find where the bleeding is coming from. I tried my best to keep up with the suction so we can identify where the bleed is coming from, but we couldn't find a specific source. At least we knew it wasn't an artery as the blood is darker in colour. Anyways it was just a big mess in there and slowly it became obvious that this surgery is going to take a lot longer than predicted. The anaesthetist was struggling to keep the patient's stats normal and eventually had to call in for blood. We took a break during the surgery to try and get the patient to clot by packing the wound with swabs and putting pressure. After a bit, we hoped the swabs did the trick and started removing the swabs (which also gave the anaesthetist time to catch up with the fluids) and 5 seconds after removing the swabs...the blood just came pouring out.
12.30 - removing the femoral stem component
This wasn't too hard and everything came out very easily as the bone was dead and very weak. The cement and the component came out without much difficulty...luckily. Then we had to remove the acetabular cup which proved very challenging...to the point we had to get creative. Anyways after a lot of creativity and trial and error we did get the cup out. Again the bleeding was still really bad and it was so hard to keep up with the suction and to keep the view clear. There were times where we were sloshing around blindly trying to feel for the anatomy instead of visualizing as it was far too difficult. At this point I was starting to lose track of time as I was completely focused on my job of suctioning and holding tissue out of the way, etc. As time went I could tell we were taking awhile as my feet were starting to hurt. My hands were starting to cramp up due to the gloves. My back was starting to stiffen up. Oh and I had to use the toilet...but guess what: too bad.
14.30 - making antibiotic cement beads
Essentially we leave these beads inside the patient to allow the antibiotics to work and to kill off the infection in the local area. After the patient has healed from this surgery...these beads will be taken out in the 2nd stage revision and a new joint would be put in.
14.50 - patient starting to really deteriorate
While we are operating...it is difficult to hear what is going on outside of the operating area as we are in a "tent" area with plastic walls, but you could hear the anaesthetist making a lot of calls for extra help. People were starting to come in and you know something isn't right.
15.00 - closing up the wound
We started closing up the wound and then I heard my supervisor tell the scrub nurse: "vicryl to the student as well please". I was a bit confused as to why my supervisor and I both each had sutures as usually only one person would close up while the other person uses the scissors to cut the stitch (which is usually my job). My supervisor told me to start on the bottom end of the wound and he went off and started closing up the top portion of the wound. Last time I sutured, my supervisor watched me and guided me. This being my 3rd (?) time suturing on a real person...no one is watching. Worst bit: I was also shaking like a leaf. No I wasn't nervous/scared...it was because the last time I ate was at 8.00am and was obviously starving. Anyways managed to close up the bottom of the wound and then proceeded to help my supervisor with cutting and pushing the skin closer together so he can close up properly. Other than the shaking...I didn't struggled with the knots or anything. It actually went fine and my supervisor said my sutures looked fine as well. Proud moment. Thank goodness for masks as I was probably smiling like an idiot.
15.30 - put dressing on the wound (which was leaking out with blood still) and clean up
As we took down the drapes and everything you really notice that the patient isn't doing well as hiding in the back were 4 other people helping the anaesthetist and the floor was covered with empty blood bags. At one point the patient's haemoglobin count dropped to 6 (normal is 12). Apparently the patient had no clotting factors as well and we suspected the patient had DIC (disseminated intravascular coagulation) as the patient was bleeding from the cannula sites and from her nose. By the end of surgery it was calculated that the patient had lost up to 10 litres of blood. Normal human has about 5 litres of blood. It wasn't good and the patient was obviously in a critical state. There was a student nurse watching the surgery so I went over to go talk to her. She initially thought I was also a surgeon and hadn't realized I was a medical student. I was a bit shocked as I thought it would be obvious as I'm the "clumsy" medical student that probably looked lost and clueless during the surgery. The student nurse quickly disagreed and said that she was amazed how it looked like I knew what I was doing and what needed to be done. She thought I was constantly on the same page with the consultant and I didn't need much direction. It was weird hearing that as I always though I looked like a clueless idiot when scrubbed in. Even the other theatre staff gave me a pat on the back and told me I did a good job. Definitely put a huge smile on my face and the surgery felt good. I really enjoyed it and it was exciting. The surgery was also definitely challenging so it was an interesting case for me.
Anyways first time being a first assistant for orthopaedic surgery and a good way to end my last theatre list for this placement. The patient ended up getting transferred to ICU, but she managed to recover so all was good. Definitely a very tiring day. By the time I got home it was around 1800 and I still had not eaten, but guess what...it was fine and I think it is something I have to get used to. My supervisor also hadn't eaten as well and he doesn't complain as I'm sure skipping lunch is a usual thing for him. What a day.
Anyways yesterday was theatre day and was expecting to have 3 patients on the theatre list but I was actually disappointed in the morning to find out that one of the patients were cancelled so we only had two patients on the list. It was also going to be my last orthopaedic theatre list for this placement so I was a bit bummed out that we were most likely going to finish early. First patient was a simple straight forward one man job so I didn't scrub in and just observed. Afterwards we had a good break prior to the next and final patient for the day. Had some good banter with my supervisor and then I went to go see the patient in the anaesthetic room. It was a bit weird as the anaesthetist had quite a bit of difficulty putting in an epidural and other things just weren't going right/straight forward. The anaesthetist and I had a bit of a chat and we agreed that we have a feeling this surgery is going to be FAR from straightforward. Anyways after the patient was put to sleep my supervisor came in and told me that I will be scrubbing in and will be a first assistant. My eyes lit up. Last few weeks, I was scrubbed in, but I was more of an observer who did a bit of suction here and there, but nothing really special/that helpful.
Brief summary of patient: 1st stage revision of total hip replacement. Reason: Infection
11.10 - first incision made
I am still a bit new to orthopaedic surgery, but I have seen a few now and I knew immediately that something wasn't right. Immediately after the first incision, the patient was bleeding a lot more than usual. As we went deeper, it was obvious that the bleeding is only going to get worse and by the time we got to the muscle layers...it was like the flood gates were opened. The patient was bleeding from all sides of the opening and it was difficult to find where the bleeding is coming from. I tried my best to keep up with the suction so we can identify where the bleed is coming from, but we couldn't find a specific source. At least we knew it wasn't an artery as the blood is darker in colour. Anyways it was just a big mess in there and slowly it became obvious that this surgery is going to take a lot longer than predicted. The anaesthetist was struggling to keep the patient's stats normal and eventually had to call in for blood. We took a break during the surgery to try and get the patient to clot by packing the wound with swabs and putting pressure. After a bit, we hoped the swabs did the trick and started removing the swabs (which also gave the anaesthetist time to catch up with the fluids) and 5 seconds after removing the swabs...the blood just came pouring out.
12.30 - removing the femoral stem component
This wasn't too hard and everything came out very easily as the bone was dead and very weak. The cement and the component came out without much difficulty...luckily. Then we had to remove the acetabular cup which proved very challenging...to the point we had to get creative. Anyways after a lot of creativity and trial and error we did get the cup out. Again the bleeding was still really bad and it was so hard to keep up with the suction and to keep the view clear. There were times where we were sloshing around blindly trying to feel for the anatomy instead of visualizing as it was far too difficult. At this point I was starting to lose track of time as I was completely focused on my job of suctioning and holding tissue out of the way, etc. As time went I could tell we were taking awhile as my feet were starting to hurt. My hands were starting to cramp up due to the gloves. My back was starting to stiffen up. Oh and I had to use the toilet...but guess what: too bad.
14.30 - making antibiotic cement beads
Essentially we leave these beads inside the patient to allow the antibiotics to work and to kill off the infection in the local area. After the patient has healed from this surgery...these beads will be taken out in the 2nd stage revision and a new joint would be put in.
14.50 - patient starting to really deteriorate
While we are operating...it is difficult to hear what is going on outside of the operating area as we are in a "tent" area with plastic walls, but you could hear the anaesthetist making a lot of calls for extra help. People were starting to come in and you know something isn't right.
15.00 - closing up the wound
We started closing up the wound and then I heard my supervisor tell the scrub nurse: "vicryl to the student as well please". I was a bit confused as to why my supervisor and I both each had sutures as usually only one person would close up while the other person uses the scissors to cut the stitch (which is usually my job). My supervisor told me to start on the bottom end of the wound and he went off and started closing up the top portion of the wound. Last time I sutured, my supervisor watched me and guided me. This being my 3rd (?) time suturing on a real person...no one is watching. Worst bit: I was also shaking like a leaf. No I wasn't nervous/scared...it was because the last time I ate was at 8.00am and was obviously starving. Anyways managed to close up the bottom of the wound and then proceeded to help my supervisor with cutting and pushing the skin closer together so he can close up properly. Other than the shaking...I didn't struggled with the knots or anything. It actually went fine and my supervisor said my sutures looked fine as well. Proud moment. Thank goodness for masks as I was probably smiling like an idiot.
15.30 - put dressing on the wound (which was leaking out with blood still) and clean up
As we took down the drapes and everything you really notice that the patient isn't doing well as hiding in the back were 4 other people helping the anaesthetist and the floor was covered with empty blood bags. At one point the patient's haemoglobin count dropped to 6 (normal is 12). Apparently the patient had no clotting factors as well and we suspected the patient had DIC (disseminated intravascular coagulation) as the patient was bleeding from the cannula sites and from her nose. By the end of surgery it was calculated that the patient had lost up to 10 litres of blood. Normal human has about 5 litres of blood. It wasn't good and the patient was obviously in a critical state. There was a student nurse watching the surgery so I went over to go talk to her. She initially thought I was also a surgeon and hadn't realized I was a medical student. I was a bit shocked as I thought it would be obvious as I'm the "clumsy" medical student that probably looked lost and clueless during the surgery. The student nurse quickly disagreed and said that she was amazed how it looked like I knew what I was doing and what needed to be done. She thought I was constantly on the same page with the consultant and I didn't need much direction. It was weird hearing that as I always though I looked like a clueless idiot when scrubbed in. Even the other theatre staff gave me a pat on the back and told me I did a good job. Definitely put a huge smile on my face and the surgery felt good. I really enjoyed it and it was exciting. The surgery was also definitely challenging so it was an interesting case for me.
Anyways first time being a first assistant for orthopaedic surgery and a good way to end my last theatre list for this placement. The patient ended up getting transferred to ICU, but she managed to recover so all was good. Definitely a very tiring day. By the time I got home it was around 1800 and I still had not eaten, but guess what...it was fine and I think it is something I have to get used to. My supervisor also hadn't eaten as well and he doesn't complain as I'm sure skipping lunch is a usual thing for him. What a day.
Wednesday, May 23, 2012
Empathy.
Empathy is probably one of the most popular answers to medical interview questions such as "skills required to be a doctor." Empathy is essentially the skill to be able to feel another person's feelings. To be entirely honest...it seems like it is a skill that you LOSE, not gain as your career progresses. As a medical student, I treat the patients with a lot of respect and take the time to listen to them and try to empathize and sympathize with them. It is definitely not an easy task. There are countless amount of times where I found myself fake sympathizing/empathizing with patients as I sometimes find it very difficult to place myself in his or her shoes. And some of you may think why you "lose" your empathy skill as you progress through your career. Obviously this is a generalization and there are definitely lots of consultants out there who are really good at empathizing with patients; however, there are some where you start questioning their bedside manners.
I really don't blame the consultants for not empathizing with patients. After doing your job for 30-something years, you might not be as interested in it as you were 30 years ago. Some consultants have extremely busy schedules and it is a shame they don't take the time to empathize with patients. With an aging population, we now see a lot of elderly patients on the wards with chronic conditions. These patients might be in for their 10th surgery on their hip, for example. Sometimes it is unfortunate that surgeons/doctors don't acknowledge these things. Yeah you need to fix a patient's hip, but after having so many surgeries, it is obviously going to affect the patient psychologically and socially. I know there are some doctors who believe in holistic medicine. These doctors would tend to all the needs of the patient: psychological, physical, and social. I feel like the patients who have these sort of doctors feel like they are cared for and sometimes I guess it is pretty frustrating to be tossed between 5 different teams in a hospital as consultants won't know you as well.
Then we start to asking the question: are doctors too specialized? I mean just under orthopaedics, we've got consultants who specialize in only hip replacements, or hand surgery, etc. With such specialized doctors, we start to realize that these doctors start to lose knowledge about other systems in the body. In hospital for hip replacement but have a breathing problem so the orthopod has to refer you to the respiratory team. Are we becoming too one dimensional? It's definitely a tough argument. By having such specialized doctors/surgeons, we get people who are excellent at their field. If we have a bunch of doctors who knows a bit of everything...well we get doctors who are just good at everything and not excellent in anything. It's a tough argument, but to be honest, I would much prefer having a very specialized doctor as I would know for sure that he or she is fantastic at treating a certain condition or performing certain surgical procedures. If my life is at risks...I would obviously want the best and only the best.
Hmm...think I got a bit off topic there. Anyways empathy. It is a shame that some doctors lose this skill and overlook a patient's social/psychological well-being. But like I said earlier...I really don't blame them. I hope I will still be good at empathizing with patients 30 years down the line, but I know it will be something I will have to keep reminding myself to do. What's the point of being rude to patients? You gain nothing. Might as well be nice and listen to them and make their stay at the hospital better. Easy to say...hard to do.
I really don't blame the consultants for not empathizing with patients. After doing your job for 30-something years, you might not be as interested in it as you were 30 years ago. Some consultants have extremely busy schedules and it is a shame they don't take the time to empathize with patients. With an aging population, we now see a lot of elderly patients on the wards with chronic conditions. These patients might be in for their 10th surgery on their hip, for example. Sometimes it is unfortunate that surgeons/doctors don't acknowledge these things. Yeah you need to fix a patient's hip, but after having so many surgeries, it is obviously going to affect the patient psychologically and socially. I know there are some doctors who believe in holistic medicine. These doctors would tend to all the needs of the patient: psychological, physical, and social. I feel like the patients who have these sort of doctors feel like they are cared for and sometimes I guess it is pretty frustrating to be tossed between 5 different teams in a hospital as consultants won't know you as well.
Then we start to asking the question: are doctors too specialized? I mean just under orthopaedics, we've got consultants who specialize in only hip replacements, or hand surgery, etc. With such specialized doctors, we start to realize that these doctors start to lose knowledge about other systems in the body. In hospital for hip replacement but have a breathing problem so the orthopod has to refer you to the respiratory team. Are we becoming too one dimensional? It's definitely a tough argument. By having such specialized doctors/surgeons, we get people who are excellent at their field. If we have a bunch of doctors who knows a bit of everything...well we get doctors who are just good at everything and not excellent in anything. It's a tough argument, but to be honest, I would much prefer having a very specialized doctor as I would know for sure that he or she is fantastic at treating a certain condition or performing certain surgical procedures. If my life is at risks...I would obviously want the best and only the best.
Hmm...think I got a bit off topic there. Anyways empathy. It is a shame that some doctors lose this skill and overlook a patient's social/psychological well-being. But like I said earlier...I really don't blame them. I hope I will still be good at empathizing with patients 30 years down the line, but I know it will be something I will have to keep reminding myself to do. What's the point of being rude to patients? You gain nothing. Might as well be nice and listen to them and make their stay at the hospital better. Easy to say...hard to do.
Sunday, May 13, 2012
Too slack?!
Some of you have probably noticed that I am back from holiday due to my recent post. Anyways you must be thinking what placement I must be on. Essentially we get 6 weeks where we can either design our own placement or select a project that the school offers. Most of you probably know that I am interested in Orthopaedics, so I designed my own placement and have chosen to spend 6 weeks in Orthopaedics. So far...well so far I haven't really done much as my supervisor has been taking quite a few annual leaves. I've been in for about 3 days in the last 2 weeks. I've been to 2 clinics, which were quite good. My supervisor is quite good at teaching so I'm definitely learning lots...just wish I was in more often. Yes I am whining about not having enough to do. It doesn't help that my last placement was quite busy (in from 9am to at least 5pm every day). Now I'm in for a half day here and there. I got 1 theatre day which was alright. For the first surgery I didn't get to scrub in because the nurses didn't realize I was attached to the consultant and no one helped me scrub in. For the rest of the list I got to scrub in and it was definitely interesting. Looked ridiculous though fully decked out in gear as in Orthopaedics they are quite anal about cleanliness as they want to prevent infections. If the patient gets an infection, the only way of curing it is to take the implant out so we all want it to go successfully. No one wants to go under the knife more than once. My supervisor was really good at getting me involved though. I mean scrubbing in was already good enough but my supervisor also let me use the drill, hammer, etc. It definitely put a smile on my face and I really enjoyed it. I also got to learn how to stitch (finally) and I got to help close up at the end of surgery.
Anyways there isn't much to post about unfortunately as I haven't actually had a proper full week yet. It's quite frustrating. I'm actually keen to do some work and stuff, but I haven't even really touched base with my supervisor so I hardly know what is going on. I mean I've gotten to know the registrar which is good, but with going into theatre, the consultants are generally quite picky about having students in and I haven't had a chance to meet all the consultants on the team yet. Really difficult to keep my motivation up to go into placement at the moment. A bit disappointed as well, but once my supervisor gets back I'm sure everything will get going again (I hope).
Anyways there isn't much to post about unfortunately as I haven't actually had a proper full week yet. It's quite frustrating. I'm actually keen to do some work and stuff, but I haven't even really touched base with my supervisor so I hardly know what is going on. I mean I've gotten to know the registrar which is good, but with going into theatre, the consultants are generally quite picky about having students in and I haven't had a chance to meet all the consultants on the team yet. Really difficult to keep my motivation up to go into placement at the moment. A bit disappointed as well, but once my supervisor gets back I'm sure everything will get going again (I hope).
Saturday, March 31, 2012
O&G Labour Week Part 2.
Tiring second half of the week. No joke. Again I underestimated/didn't give labour week enough credit. I thought it was going to be complete crap...but this week has proven me wrong. I wouldn't say obstetrics is my cup of tea, BUT it has certainly earned a lot more respect from me. The midwives are so hard working and enthusiastic despite their ridiculously long shifts. I think the most frustrating part about obstetrics is that it is either very busy or very quiet. When it is busy, time passes by extremely quickly...but when it is quiet - holy smokes...it is painful as all you do is just sit around and zone out.
Day 3 - Because I only had 1 thing left to be signed off on my log book (instrumental delivery) I was literally running around and broadcasting to the midwives and doctors that I need to see an instrumental delivery. Essentially showed up early...again struggled with arriving for 7am, but tried my best. The midwives suspected that one of the rooms will need an instrumental delivery so they told me to keep an eye out. Literally sat and waited for the whole day for this woman to deliver. So a bit of background.
Essentially I had been hovering around this lady's room and keeping an hawk eye on the midwife responsible for this lady as I did not want to miss an instrumental delivery. Sat around in the midwife room for hours. Time was ticking and it was getting closer to the end of my shift (5pm)...then 4:50pm - midwife reports that the lady is fully dilated and has tried to push for awhile but the baby was not coming out - called on-call registrar. It was determined that this woman will need instrumental delivery. I obviously perked up and was relieved that I will finally get to observe an instrumental delivery and get my log book obstetrics section completed.
Lady was brought into theatre as there was a bit of cervix which could be pushed back and she was given spinal. Realized that we cannot use the KIWI so we had to use Forceps. I had never seen forceps before and when I saw them it looked pretty crude but it doesn't really do any damage to the baby. Forceps delivery is just crude. The registrar was pulling quite hard and we had to hold the lady back as she kept sliding down the bed as we pulled. The husband nearly passed out as well. After several attempts, the baby was delivered and it was fairly large so I was not surprised why it took a few pulling attempts. Unfortunately, due to the baby's large head and that the lady was quite small, she ended up with a 3rd degree tear. 3rd degree tear = torn perineum and a bit of anal sphincter. Essentially tears are not pretty...seen a few tears now and it's not nice. Essentially the surgeon has to stitch your perineum back together which is pretty much a mess. It isn't pretty. I don't even get how does the surgeon figure out what to stitch. To me it was just a bunch of flesh torn apart. Certainly looks very difficult to repair and requires a lot of skill and experience. Amazing though. Once that was done it was almost 6pm but the extra hour got me my final signature for my log book.
Day 4 - because my log book was filled and it was a half day as I have a night shift on day 5...i turned up late and observed 2 caesarean sections. Fairly boring day.
Day 5 - 16 hour on-call night shift. Start at 5pm Friday, finish 9am Saturday. I really didn't know what to expect...I like to consider myself nocturnal as I work well in the middle of the night. Unfortunately it was a VERY quiet night and time was crawling. I didn't know what is the proper etiquette for night shifts...do I go sleep or do I stay awake with the midwives? The doctors disappeared midway through the night and I assume they went back to their office to sleep. So what do I do? Essentially I tried my best to stay awake and read 6 chapters of my O&G textbook. 4am - I was getting fed up. Bored to death. Nothing going on. 5am - told the midwives to bleep me if there's anything interesting/if they need to bleep the doctors to also please bleep me. I technically don't have a room but I reckoned the seminar room would be empty so I went to bum on the couch in there. Passed out for about 30 minutes and then my bleep went off. I was so tired...I looked at my bleep and was trying to get up...couldn't. 15 minutes later - woke up and sun was rising...obviously hardly knew where I was...very dazed. I could hardly open my eyes and zombie stumbled to the ward and the midwives said they were trying to bleep me and that there's a patient in theatre. Went to theatre to see the consultant repairing a 3rd degree tear. I'm pretty sure he knew why I was late...but he didn't say anything. Phew. 8:30am - doctor handover. I packed up, got changed back into clinical clothing, and then stumbled to my car. Managed to get home in one piece. But wow WHAT A TIRING/BORING NIGHT. Brutal. Never again - 16 hours. Doctors and midwives only do 12 hour shifts...why the heck do students have to do 16 hour shifts?! Trying to kill us?! At least give us a room or an office instead so we can rest.
All in all...labour week wasn't too shabby. Obviously Monday and Tuesday were my highlight days as I got to assist and scrub in for elective sections. Very good experience as I enjoy surgery so any opportunity to scrub in is an honour for me. Next week is my final "timetabled" week which is Ward Week; however, it is more like 50% ward, 50% clinic. My summative assessment is next Tuesday as well. It involves taking a full Gynaecological history and answering questions about investigations, management, and treatment. Quite nervous as I haven't had time to practice history taking as I haven't had my ward week. Next Monday = catch up time. Probably going to try my best to talk to as many patients as I can on the ward. Final stretch of placement: 2 more weeks. Ward week then "catch-up" week. I'm actually kinda sad that this attachment is ending. Having a blast. Unexpected. Wow.
Day 3 - Because I only had 1 thing left to be signed off on my log book (instrumental delivery) I was literally running around and broadcasting to the midwives and doctors that I need to see an instrumental delivery. Essentially showed up early...again struggled with arriving for 7am, but tried my best. The midwives suspected that one of the rooms will need an instrumental delivery so they told me to keep an eye out. Literally sat and waited for the whole day for this woman to deliver. So a bit of background.
27 year old woman
Prima Gravida (first pregnancy)
Been in labour for 48 hours
Admitted to hospital with cervix dilatation approx 5cm and severe contraction pains
SROM (spontaneous rupture of membrane)
CTG revealed an episode of deceleration of fetal heart - spontaneously resolved - may need C-section if re-occur
FBS (fetal blood sample) taken x2 (both revealed normal blood results)
Plan: Midwife to review every 2 hours for any more CTG decelerations.
Essentially I had been hovering around this lady's room and keeping an hawk eye on the midwife responsible for this lady as I did not want to miss an instrumental delivery. Sat around in the midwife room for hours. Time was ticking and it was getting closer to the end of my shift (5pm)...then 4:50pm - midwife reports that the lady is fully dilated and has tried to push for awhile but the baby was not coming out - called on-call registrar. It was determined that this woman will need instrumental delivery. I obviously perked up and was relieved that I will finally get to observe an instrumental delivery and get my log book obstetrics section completed.
Lady was brought into theatre as there was a bit of cervix which could be pushed back and she was given spinal. Realized that we cannot use the KIWI so we had to use Forceps. I had never seen forceps before and when I saw them it looked pretty crude but it doesn't really do any damage to the baby. Forceps delivery is just crude. The registrar was pulling quite hard and we had to hold the lady back as she kept sliding down the bed as we pulled. The husband nearly passed out as well. After several attempts, the baby was delivered and it was fairly large so I was not surprised why it took a few pulling attempts. Unfortunately, due to the baby's large head and that the lady was quite small, she ended up with a 3rd degree tear. 3rd degree tear = torn perineum and a bit of anal sphincter. Essentially tears are not pretty...seen a few tears now and it's not nice. Essentially the surgeon has to stitch your perineum back together which is pretty much a mess. It isn't pretty. I don't even get how does the surgeon figure out what to stitch. To me it was just a bunch of flesh torn apart. Certainly looks very difficult to repair and requires a lot of skill and experience. Amazing though. Once that was done it was almost 6pm but the extra hour got me my final signature for my log book.
Day 4 - because my log book was filled and it was a half day as I have a night shift on day 5...i turned up late and observed 2 caesarean sections. Fairly boring day.
Day 5 - 16 hour on-call night shift. Start at 5pm Friday, finish 9am Saturday. I really didn't know what to expect...I like to consider myself nocturnal as I work well in the middle of the night. Unfortunately it was a VERY quiet night and time was crawling. I didn't know what is the proper etiquette for night shifts...do I go sleep or do I stay awake with the midwives? The doctors disappeared midway through the night and I assume they went back to their office to sleep. So what do I do? Essentially I tried my best to stay awake and read 6 chapters of my O&G textbook. 4am - I was getting fed up. Bored to death. Nothing going on. 5am - told the midwives to bleep me if there's anything interesting/if they need to bleep the doctors to also please bleep me. I technically don't have a room but I reckoned the seminar room would be empty so I went to bum on the couch in there. Passed out for about 30 minutes and then my bleep went off. I was so tired...I looked at my bleep and was trying to get up...couldn't. 15 minutes later - woke up and sun was rising...obviously hardly knew where I was...very dazed. I could hardly open my eyes and zombie stumbled to the ward and the midwives said they were trying to bleep me and that there's a patient in theatre. Went to theatre to see the consultant repairing a 3rd degree tear. I'm pretty sure he knew why I was late...but he didn't say anything. Phew. 8:30am - doctor handover. I packed up, got changed back into clinical clothing, and then stumbled to my car. Managed to get home in one piece. But wow WHAT A TIRING/BORING NIGHT. Brutal. Never again - 16 hours. Doctors and midwives only do 12 hour shifts...why the heck do students have to do 16 hour shifts?! Trying to kill us?! At least give us a room or an office instead so we can rest.
All in all...labour week wasn't too shabby. Obviously Monday and Tuesday were my highlight days as I got to assist and scrub in for elective sections. Very good experience as I enjoy surgery so any opportunity to scrub in is an honour for me. Next week is my final "timetabled" week which is Ward Week; however, it is more like 50% ward, 50% clinic. My summative assessment is next Tuesday as well. It involves taking a full Gynaecological history and answering questions about investigations, management, and treatment. Quite nervous as I haven't had time to practice history taking as I haven't had my ward week. Next Monday = catch up time. Probably going to try my best to talk to as many patients as I can on the ward. Final stretch of placement: 2 more weeks. Ward week then "catch-up" week. I'm actually kinda sad that this attachment is ending. Having a blast. Unexpected. Wow.
Tuesday, March 27, 2012
O&G Labour Week Part 1.
I'm only 2 days in to my labour week and I'm already struggling. I'm supposed to be in for midwives handover at 7am every day. Day 1 - alarm clock for 5:45am...next thing I knew I woke up again and it was 6:30am. Didn't get to the hospital til 7:10am...by the time I got changed into scrubs for labour ward...it was like 7:20am. Day 2 - alarm clock for 5:45am...actually got up this time. Arrived at the hospital at 6:55am and traffic wasn't bad. I actually tried really hard to make it to handover...ran to get changed. By the time I got out...I had apparently missed handover already and the midwives said I should aim to arrive for 6:50am tomorrow. In my head I was like "6:50am?! Yeaaahhh right." Dreading it already. Also I have been sooo tired. I would sometimes catch myself dozing off in the ward because I start so early in the morning...but still get off at 5ish pm. Brutal. And when I get home...I hardly have the energy to eat and all I want to do is sleep. So unproductive.
Pretty exciting first day though. Saw 2 normal vaginal deliveries. Also assisted as a first assistant on 2 caesarean sections (aka I got to scrub in and actually do proper surgical stuff...not just hang around and watch - just the consultant surgeon, me, and a scrub nurse - what a dream). Also witnessed an emergency caesarean section as the baby was stuck. When the emergency button was pressed it was like a TV show. It was crazy. Loads of people ran in within 5 seconds of the buzzer going off and everyone knew what they were doing. Anaesthetist was already making his way to theatre and some of the theatre staff darted to theatre to prep. About 8 of us were racing the bed down to theatre. It was really surreal. Obviously there was a sense or urgency. The mother had to be put under general anaesthetic (most caesareans is under spinal so the mother stays awake and just can't feel anything down below). Staff was frantically prepping the theatre with the equipment...it was just organized chaos. I was so scared to get in the way so I just crammed myself into a tiny corner of the room. I obviously couldn't scrub in as it was an emergency and the registrar had turned up. Eventually we managed to get the baby out and I finally got to see the link between the paediatricians and obstetricians. The paeds team was already waiting for us ready for the baby and for any resuscitation as it was a complicated birth. Baby came out floppy and wasn't crying/breathing. It was a very tense moment as we handed the baby over to the paeds team. Unfortunately I'm with the obstetrics team so I couldn't go watch the paeds team work their magic. Finally after a few tense minutes we heard the baby cry and you could see the relief on some of the staffs' faces. I'm sure it was pretty scary for the mother herself as one minute she was just about to give birth but the baby got stuck..the next minute she's asleep. Also the father is left waiting outside of theatre after seeing a bunch of people wheel off his wife. Pretty scary situation for the family in general I would think. I couldn't say I had as much fun in the afternoon though. Immensely boring after a frantic morning. But the morning certainly made my day though.
Day 2 - quiet morning. Waited til 9am for elective caesarean sections. Again was really lucky and got asked to scrub in and help out...but not to the certain extent of a first assistant. Still makes a huge difference when you're scrubbed in. I even got to transfer the newborn to the crib after we pulled him out. It was really cool. After the sections...again went quiet again. Saw 1 normal delivery and that was it. Next thing to knock off my list: Instrumental Delivery (eg. using Forceps or Ventouse Suction). Really need to get that signed off tomorrow.
Labour week to be continued.......(if I'm still alive by the end of it)
Pretty exciting first day though. Saw 2 normal vaginal deliveries. Also assisted as a first assistant on 2 caesarean sections (aka I got to scrub in and actually do proper surgical stuff...not just hang around and watch - just the consultant surgeon, me, and a scrub nurse - what a dream). Also witnessed an emergency caesarean section as the baby was stuck. When the emergency button was pressed it was like a TV show. It was crazy. Loads of people ran in within 5 seconds of the buzzer going off and everyone knew what they were doing. Anaesthetist was already making his way to theatre and some of the theatre staff darted to theatre to prep. About 8 of us were racing the bed down to theatre. It was really surreal. Obviously there was a sense or urgency. The mother had to be put under general anaesthetic (most caesareans is under spinal so the mother stays awake and just can't feel anything down below). Staff was frantically prepping the theatre with the equipment...it was just organized chaos. I was so scared to get in the way so I just crammed myself into a tiny corner of the room. I obviously couldn't scrub in as it was an emergency and the registrar had turned up. Eventually we managed to get the baby out and I finally got to see the link between the paediatricians and obstetricians. The paeds team was already waiting for us ready for the baby and for any resuscitation as it was a complicated birth. Baby came out floppy and wasn't crying/breathing. It was a very tense moment as we handed the baby over to the paeds team. Unfortunately I'm with the obstetrics team so I couldn't go watch the paeds team work their magic. Finally after a few tense minutes we heard the baby cry and you could see the relief on some of the staffs' faces. I'm sure it was pretty scary for the mother herself as one minute she was just about to give birth but the baby got stuck..the next minute she's asleep. Also the father is left waiting outside of theatre after seeing a bunch of people wheel off his wife. Pretty scary situation for the family in general I would think. I couldn't say I had as much fun in the afternoon though. Immensely boring after a frantic morning. But the morning certainly made my day though.
Day 2 - quiet morning. Waited til 9am for elective caesarean sections. Again was really lucky and got asked to scrub in and help out...but not to the certain extent of a first assistant. Still makes a huge difference when you're scrubbed in. I even got to transfer the newborn to the crib after we pulled him out. It was really cool. After the sections...again went quiet again. Saw 1 normal delivery and that was it. Next thing to knock off my list: Instrumental Delivery (eg. using Forceps or Ventouse Suction). Really need to get that signed off tomorrow.
Labour week to be continued.......(if I'm still alive by the end of it)
Saturday, March 17, 2012
O&G Theatre Week
So far so good! I'm enjoying this placement 100% more than my paediatrics placement. I feel much more comfortable and it's a nice feeling to be looked after. Yes it is annoying that someone is keeping a hawk eye on your progress and your work, BUT at least someone cares. In my last placement I felt like I could get away with anything and there wasn't enough motivation/pressure for me to work hard. I'm working much harder in this placement and I am learning loads. This week was my theatre week and as you probably know - I'm a bit biased towards surgeries as I really enjoy surgery. If you tell me to stand in theatre from 9-5 and watch surgery all day...I will happily do that - no complaints. If you tell me to stand in the ward from 9-5...I'm pretty sure I won't be as happy about that. I don't know what draws me to surgery so much. It's just nice being able to fix things immediately right there and then.
Anyways all in all the week had its highs and lows. Monday and Thursday were my two highlight days of the week. Oddly enough these two days were the two days where I had theatre sessions with my supervisor (Mr R). Right before joining Mr R for theatre, I was told by his registrar that he enjoys quizzing his students in theatre. I found it quite weird as when I was in clinic with Mr R, he didn't seem to be the "quizzing" type of consultant. Before surgery even started, I was grilled about common gynaecological problems. Luckily the questions weren't too challenging and Mr R seemed fairly impressed with my knowledge. I was just lucky that I had clinic prior to theatre which covered the conditions that Mr R quizzed me about. Phew. After the grilling, Mr R invited me to scrub in and to assist in the surgery! I was obviously very excited and it was nice being right at the table and I got to actually assist. I felt a part of the team and I felt like I was helping out. Unfortunately, this gave Mr R the opportunity to quiz me on the pelvic anatomy (which was VERY rusty). My lack of knowledge in the pelvic anatomy was not exactly impressive and I was promptly told to review my anatomy. Oops. Other than that I was able to get my hands in and I learned quite a lot as I did not get a female cadaver dissection specimen during my 2nd year so it was nice to be able to actually see the organs. I was also lucky to help out in a total hysterectomy as it was an open surgery so I got to see the organs more clearly. As the days went by I realized this was the only open surgery I will be watching as the rest of the surgeries I saw were laparoscopic surgeries. Pretty lucky to be honest. When surgery finished I had a good time and had some good banter going on during the surgery. Got to know my supervisor and the registrar better. No joke I really felt welcomed and I didn't feel so much like a medical student. I didn't feel like a joke in the theatre. People were taking me seriously and the nurses were all very friendly to me and I got along with everyone. Definitely a good start.
Tuesday I was with a different consultant for surgery and then realized to appreciate my supervisor as this consultant did not teach me at all. We were performing laparoscopic excisions of endometriosis and these were fairly complicated surgeries in general so the consultant was busy concentrating and I felt forgotten. I casually stood at the the back of the team as I was not offered to scrub in so I just observed. It was horrendously boring and I was getting fairly restless. After a fairly boring/dull Tuesday morning I went to look back at my schedule and realized I have the same consultant that I had in the morning on Thursday. I did a bit of snooping around and found out Mr R had a day theatre list Thursday morning so I decided to make amendments to my schedule and decided to follow Mr R. You would think why would I want to follow Mr R as he loves quizzing and it's quite a lot of pressure as this is my supervisor who will be assessing me at the end of my placement. After following a different consultant on Tuesday, I realized that despite all the quizzing, I learned a lot more with Mr R and in general had a lot more fun in theatre. Yes it's nice not needing to use your brain, but because I'm interested in surgery I rather get quizzed and learn things. On top of that Mr R lets me scrub in and help out so it really makes my experience a whole lot better. I guess it's a give and take situation.
Unfortunately I caught Mr R on a bad day on Wednesday and managed to "anger" him as I didn't know I was scheduled in for an audit in the afternoon as it wasn't on my schedule. Because I had my schedule in advance I decided to arrange a few meetings on that day in the afternoon as I assumed I had a half day. I had to explain to Mr R why I cannot attend the audit and he was not impressed whatsoever. I was properly pooping myself as we have been getting along and he's been pretty chill. I didn't think he would care that much about me missing an audit. I obviously felt really bad on Wednesday so I knew I had to redeem myself on Thursday. Wednesday night I decided to dust off my anatomy text books and revised my pelvic anatomy very well and read up on various gynaecological conditions. I also found out that Mr R consents his patients at 8am on Thursday prior to starting theatre so I decided to head in early and join him in his consent clinic. Let's just say he was pleasantly surprised that I was there so early and I managed to get consent from all the patients for the list in order to allow me to do examinations while she is under general anaesthesia. When in theatre I was promptly grilled on common gynaecological problems and because I had done my revision I was able to answer his questions with ease. To be honest...it was extremely satisfying. On the first patient I was told to put on a pair of gloves and to quickly do a vaginal examination. I was a bit disappointed I wasn't asked to scrub in, but I assumed Mr R was still annoyed with me from the previous day. Fair enough. I was essentially ignored for the rest of the procedure and then I guess Mr R remembered about me and then quizzed me on the pelvic anatomy. Again having revised anatomy the night before, I named all the parts with ease and Mr R was very impressed. He gave me the nod of approval and again I got that sense of satisfaction. It felt really good. Had a bit of banter in between patients and because I had "passed his test", I earned the right to scrub in for the rest of the list. It was amazing. I got to move the uterus into position for the procedures and the quizzing stopped. Yes it may sound daft "maneuvering the uterus"...big deal right? But something that small can make a huge difference to your experience in theatre. Yes I was doing a pretty dull job, but I knew I was making it easier for Mr R to perform the procedure with his registrar. I was then taught how to properly do a vaginal examination and was also taught how to do a speculum examination. I think this was the first time where Mr R took the time to teach and explain things thoroughly. Usually Mr R briefly explains things and is usually quite vague, but this time he was detailed and was really patient with me. He made sure I got a hang of it and made me do all of this with all the patients in the list. By the last patient I was doing the examinations with ease and was getting good at maneuvering the uterus. Haha. Was in a VERY good mood for the rest of the day. I was really proud of myself and it was nice getting praised by my supervisor. He seemed very impressed and I felt like I redeemed myself from the previous day's mishap. What a day.
At the same time I was a bit sad that it was my last proper theatre session for the rest of the placement. I will miss it a lot. My whole of next week are clinics and I'm not a huge fan of them. Will be a hard change and I'm sure I will be craving to go back into theatre. It was a shame I only got 2 sessions with Mr R in theatre as I learned so much. And with his quizzing, I realized I remember things much better. I guess in the end he ain't that bad of a teacher. I guess first impressions aren't always that accurate.
Anyways all in all the week had its highs and lows. Monday and Thursday were my two highlight days of the week. Oddly enough these two days were the two days where I had theatre sessions with my supervisor (Mr R). Right before joining Mr R for theatre, I was told by his registrar that he enjoys quizzing his students in theatre. I found it quite weird as when I was in clinic with Mr R, he didn't seem to be the "quizzing" type of consultant. Before surgery even started, I was grilled about common gynaecological problems. Luckily the questions weren't too challenging and Mr R seemed fairly impressed with my knowledge. I was just lucky that I had clinic prior to theatre which covered the conditions that Mr R quizzed me about. Phew. After the grilling, Mr R invited me to scrub in and to assist in the surgery! I was obviously very excited and it was nice being right at the table and I got to actually assist. I felt a part of the team and I felt like I was helping out. Unfortunately, this gave Mr R the opportunity to quiz me on the pelvic anatomy (which was VERY rusty). My lack of knowledge in the pelvic anatomy was not exactly impressive and I was promptly told to review my anatomy. Oops. Other than that I was able to get my hands in and I learned quite a lot as I did not get a female cadaver dissection specimen during my 2nd year so it was nice to be able to actually see the organs. I was also lucky to help out in a total hysterectomy as it was an open surgery so I got to see the organs more clearly. As the days went by I realized this was the only open surgery I will be watching as the rest of the surgeries I saw were laparoscopic surgeries. Pretty lucky to be honest. When surgery finished I had a good time and had some good banter going on during the surgery. Got to know my supervisor and the registrar better. No joke I really felt welcomed and I didn't feel so much like a medical student. I didn't feel like a joke in the theatre. People were taking me seriously and the nurses were all very friendly to me and I got along with everyone. Definitely a good start.
Tuesday I was with a different consultant for surgery and then realized to appreciate my supervisor as this consultant did not teach me at all. We were performing laparoscopic excisions of endometriosis and these were fairly complicated surgeries in general so the consultant was busy concentrating and I felt forgotten. I casually stood at the the back of the team as I was not offered to scrub in so I just observed. It was horrendously boring and I was getting fairly restless. After a fairly boring/dull Tuesday morning I went to look back at my schedule and realized I have the same consultant that I had in the morning on Thursday. I did a bit of snooping around and found out Mr R had a day theatre list Thursday morning so I decided to make amendments to my schedule and decided to follow Mr R. You would think why would I want to follow Mr R as he loves quizzing and it's quite a lot of pressure as this is my supervisor who will be assessing me at the end of my placement. After following a different consultant on Tuesday, I realized that despite all the quizzing, I learned a lot more with Mr R and in general had a lot more fun in theatre. Yes it's nice not needing to use your brain, but because I'm interested in surgery I rather get quizzed and learn things. On top of that Mr R lets me scrub in and help out so it really makes my experience a whole lot better. I guess it's a give and take situation.
Unfortunately I caught Mr R on a bad day on Wednesday and managed to "anger" him as I didn't know I was scheduled in for an audit in the afternoon as it wasn't on my schedule. Because I had my schedule in advance I decided to arrange a few meetings on that day in the afternoon as I assumed I had a half day. I had to explain to Mr R why I cannot attend the audit and he was not impressed whatsoever. I was properly pooping myself as we have been getting along and he's been pretty chill. I didn't think he would care that much about me missing an audit. I obviously felt really bad on Wednesday so I knew I had to redeem myself on Thursday. Wednesday night I decided to dust off my anatomy text books and revised my pelvic anatomy very well and read up on various gynaecological conditions. I also found out that Mr R consents his patients at 8am on Thursday prior to starting theatre so I decided to head in early and join him in his consent clinic. Let's just say he was pleasantly surprised that I was there so early and I managed to get consent from all the patients for the list in order to allow me to do examinations while she is under general anaesthesia. When in theatre I was promptly grilled on common gynaecological problems and because I had done my revision I was able to answer his questions with ease. To be honest...it was extremely satisfying. On the first patient I was told to put on a pair of gloves and to quickly do a vaginal examination. I was a bit disappointed I wasn't asked to scrub in, but I assumed Mr R was still annoyed with me from the previous day. Fair enough. I was essentially ignored for the rest of the procedure and then I guess Mr R remembered about me and then quizzed me on the pelvic anatomy. Again having revised anatomy the night before, I named all the parts with ease and Mr R was very impressed. He gave me the nod of approval and again I got that sense of satisfaction. It felt really good. Had a bit of banter in between patients and because I had "passed his test", I earned the right to scrub in for the rest of the list. It was amazing. I got to move the uterus into position for the procedures and the quizzing stopped. Yes it may sound daft "maneuvering the uterus"...big deal right? But something that small can make a huge difference to your experience in theatre. Yes I was doing a pretty dull job, but I knew I was making it easier for Mr R to perform the procedure with his registrar. I was then taught how to properly do a vaginal examination and was also taught how to do a speculum examination. I think this was the first time where Mr R took the time to teach and explain things thoroughly. Usually Mr R briefly explains things and is usually quite vague, but this time he was detailed and was really patient with me. He made sure I got a hang of it and made me do all of this with all the patients in the list. By the last patient I was doing the examinations with ease and was getting good at maneuvering the uterus. Haha. Was in a VERY good mood for the rest of the day. I was really proud of myself and it was nice getting praised by my supervisor. He seemed very impressed and I felt like I redeemed myself from the previous day's mishap. What a day.
At the same time I was a bit sad that it was my last proper theatre session for the rest of the placement. I will miss it a lot. My whole of next week are clinics and I'm not a huge fan of them. Will be a hard change and I'm sure I will be craving to go back into theatre. It was a shame I only got 2 sessions with Mr R in theatre as I learned so much. And with his quizzing, I realized I remember things much better. I guess in the end he ain't that bad of a teacher. I guess first impressions aren't always that accurate.
Saturday, March 10, 2012
Obs&Gynae - Initial Thoughts
So I have completed my first week of placement for Obstetrics and Gynaecology. Initial impressions? Fairly interesting. It's nice to see adult patients again. When I took my first patient history on this attachment, it was weird being able to speak directly to the patient and receiving specific information. Also in Obstetrics (pregnant women), you can't really call these people 'patients' as most of them are healthy and essentially are only in hospital to give birth. It's quite a nice change of environment from seeing ill children. In Gynaecology, one has to be quite professional as this specialty deals with quite sensitive things. You have to ask personal questions and you really need to gain the trust of your patients in order to get such personal/sensitive information. Again a huge contrast from Paediatrics as I have to put on a "fun" attitude when approaching children; however, with gynaecological patients, I have to be composed and essentially act professionally. It is a nice change and I haven't found the transition too difficult...yet. We'll see in the next few weeks.
Again I am in a peripheral hospital, but this hospital isn't actually that far away. For me, it is actually closer than the central hospital so I'm not complaining. It's great to be in a hospital which has a good reputation for teaching. They pride themselves in teaching and on day 1 it was very noticeable. The supervisor and secretary was very organized and were expecting us. We felt very welcomed and we received our schedule for the next 6 weeks! I was not expecting a schedule as in my previous attachment everything was done ad hoc and we received little guidance. Huge difference for this attachment and it was definitely a change I welcomed. It was nice knowing what you will be doing in the next few weeks and I could actually plan my life as I will know when I will be free and I can prepare ahead of time for clinics/teaching.
On top of that, I have come to realize how patient some people are. I went onto the wards to help out and was given the task of clerking in 2 new patients. These 2 patients have not seen anyone yet, so I was excited to go talk to them. The first patient I saw was having severe pain and to my surprise, she had been waiting to be seen for 4.5 hours! Talk about patience! I would've left ages ago and I found it quite ridiculous someone in so much pain has been waiting for so long! After taking the patient history, I realized this patient was in a lot of pain and a doctor had to see her soon. In addition to that, the patient was not impressed with the care so far (not surprised) so I quickly went to go get a senior doctor. It was found that she had surgery a week ago and the stitches were infected and some of it has come away. This patient was promptly admitted to the ward and was finally given stronger pain killers and a surgeon was called to review the case.
Then I went to go talk to my next patient...who actually arrived earlier than the last patient I saw. She had been waiting for 5 hours and I felt really bad for her. She had come to A+E the day before and due to the long wait she left and decided to come to the ward the next day. Because the ward was fairly busy, no one has really seen her and again I was the first person to see her. This could of easily been the longest history I had ever taken. After introducing myself I asked the standard question: "What brings you to hospital today?". This patient went on and on with a very extensive history of her presenting complaint and I was overwhelmed with information. She did not stop talking for a good 10-15 minutes and I was completely lost. I slowly had to work my way back through her history to get a more clear idea what was wrong and this clerking felt like it took ages. It didn't help that this lady's first language was not English so I had to word my questions differently and I had to try and figure out some of her medical conditions as she didn't know the names. It was the few times I actually struggled taking a patient history and this is the first time where there was a bit of a language barrier between the patient and I. It was a good challenge and it was new experience. It definitely taught me to be patient and to take things one by one. Luckily the patient was patient with me as we worked our way through the problem and her history and after 40 minutes I finally got through the history. Mind you...it usually takes me 10-15 minutes to get a full patient history. After presenting the history to a doctor I had to leave so unfortunately I could not follow up with the patient. When I came in the next day she wasn't on the ward list so I assume she didn't need to be admitted to hospital, which I guess is good news.
All in all...interesting week. It was an introductory week so it was quite light and I took things slowly as I found my bearings around the hospital. Next week is my theatre week so lots of surgeries! I can't wait!
Again I am in a peripheral hospital, but this hospital isn't actually that far away. For me, it is actually closer than the central hospital so I'm not complaining. It's great to be in a hospital which has a good reputation for teaching. They pride themselves in teaching and on day 1 it was very noticeable. The supervisor and secretary was very organized and were expecting us. We felt very welcomed and we received our schedule for the next 6 weeks! I was not expecting a schedule as in my previous attachment everything was done ad hoc and we received little guidance. Huge difference for this attachment and it was definitely a change I welcomed. It was nice knowing what you will be doing in the next few weeks and I could actually plan my life as I will know when I will be free and I can prepare ahead of time for clinics/teaching.
On top of that, I have come to realize how patient some people are. I went onto the wards to help out and was given the task of clerking in 2 new patients. These 2 patients have not seen anyone yet, so I was excited to go talk to them. The first patient I saw was having severe pain and to my surprise, she had been waiting to be seen for 4.5 hours! Talk about patience! I would've left ages ago and I found it quite ridiculous someone in so much pain has been waiting for so long! After taking the patient history, I realized this patient was in a lot of pain and a doctor had to see her soon. In addition to that, the patient was not impressed with the care so far (not surprised) so I quickly went to go get a senior doctor. It was found that she had surgery a week ago and the stitches were infected and some of it has come away. This patient was promptly admitted to the ward and was finally given stronger pain killers and a surgeon was called to review the case.
Then I went to go talk to my next patient...who actually arrived earlier than the last patient I saw. She had been waiting for 5 hours and I felt really bad for her. She had come to A+E the day before and due to the long wait she left and decided to come to the ward the next day. Because the ward was fairly busy, no one has really seen her and again I was the first person to see her. This could of easily been the longest history I had ever taken. After introducing myself I asked the standard question: "What brings you to hospital today?". This patient went on and on with a very extensive history of her presenting complaint and I was overwhelmed with information. She did not stop talking for a good 10-15 minutes and I was completely lost. I slowly had to work my way back through her history to get a more clear idea what was wrong and this clerking felt like it took ages. It didn't help that this lady's first language was not English so I had to word my questions differently and I had to try and figure out some of her medical conditions as she didn't know the names. It was the few times I actually struggled taking a patient history and this is the first time where there was a bit of a language barrier between the patient and I. It was a good challenge and it was new experience. It definitely taught me to be patient and to take things one by one. Luckily the patient was patient with me as we worked our way through the problem and her history and after 40 minutes I finally got through the history. Mind you...it usually takes me 10-15 minutes to get a full patient history. After presenting the history to a doctor I had to leave so unfortunately I could not follow up with the patient. When I came in the next day she wasn't on the ward list so I assume she didn't need to be admitted to hospital, which I guess is good news.
All in all...interesting week. It was an introductory week so it was quite light and I took things slowly as I found my bearings around the hospital. Next week is my theatre week so lots of surgeries! I can't wait!
Sunday, February 12, 2012
Planning Ahead.
I would like to think I am fairly good at planning ahead. I am quite a simple person and fairly straight forward, but few know that I actually think quite a bit about the future. Being an international student, you have to think about the future. We try our best to not think about the future as anything can happen, but we also have to be ready for anything unexpected. My biggest advice to international students (no matter how confident you are about staying in the UK) is to have a backup plan. What happens if the UK government decide to throw us a curve ball and change the immigration/Visa rules? What happen if you suddenly have to return home due to family issues? And if you're not planning on staying in the UK, you really got to plan when to take the registry exams such as USMLE. It pains me when I see international students not having a single clue what they'll be doing in a few years time. Unfortunately it isn't a straight path for international students, let it be staying in the UK or going back home. Either way it won't be easy and you will have to make sacrifices. Anyways enough with the grim outlook for international students. It isn't all that bad to be honest. It's just that you have to constantly remind yourself you are an international student and it isn't a simple straight path. There will be many obstacles to cross and many walls to climb. It isn't easy, but hopefully it'll be all worth it in the end.
Anyways enough with the weird banter paragraph above. Maybe I should put the beer away. Haha. If you guys read my last post carefully, I did not talk about Friday. No I didn't have lectures...and no I did not go into placement. Then you must assume I was skiving. No I wasn't skiving either...well I wouldn't consider it skiving because I was actually doing something productive. I had a meeting with an Orthopaedic consultant at the central hospital to discuss about my Student Selected Component (SSC) project for this coming May. The last time I met the consultant, I fell asleep in the chair and he had to wake me up...great first impression. Luckily it didn't really affect him as he was willing to see me again. He was actually quite keen to be my supervisor for my SSC and to mentor me. This time prior to meeting him, I made sure I was not going to fall asleep. I heard him come out from his office so I made sure I didn't look like I was dozing off...to be honest I was zoning out as all I did was stare at the wall. I had to wait for awhile as I was 30 minutes early for the meeting as I messed up on my travel timing so I was quite tired. Went into the office to discuss what I will be doing for my 6 week SSC project. We did a lot of brainstorming and came up with quite a few ideas. Either this consultant is smart or was prepared to discuss about my SSC as he was rapid firing ideas at me. Unfortunately, I kept zoning out as to be fair...I did not understand half the things he mentioned. He was talking about the different type of implants used in Orthopaedics, and obviously I have never heard of the brands. He talked to me like I knew all the brands so you could imagine I was very lost. When I get lost...I zone out. It's a horrible trait I have. As he went on, he realized he should write down what I will be doing. He set out a bunch of aims and wanted me to expand on it and give it a think. He filled up half a page with notes on the aims of my project (looking at implants). I quickly put the paper away in my bag without looking at the paper.
And then I perked up as the consultant mentioned that during my project he wants to do some clinical things with me. I told him that I got to observe a few trauma surgeries and paeds orthopaedic surgeries over the last few weeks. He ended up throwing a curve-ball at me and told me that it is good that I'm making the effort and be keen to go see these things, BUT the difference is that when I follow him I will be scrubbing in and actually assisting. Oh man, I got so excited it was ridiculous. I immediately sat up straight and couldn't stop smiling. Scrubbing in and assisting = music to my ears. Finally I get the chance to get my hands in and do something that I am interested in. He also went on how I will be able to do some stitching (heart sank a bit as the last time I learned stitching was a year ago). Now, I was very excited about my SSC and the consultant surely knows how to make a student happy.
After the meeting I quickly went home and took out the paper that he wrote on. To my demise, I could not make out half the things he wrote. I regretted zoning out and I should've remembered doctors do not write legibly. Took me ages to decipher what the consultant wrote. In the end, I figured out most of the things he wrote as I vaguely remembered the stuff he was talking about and managed to crack on with expanding on his notes. Note to self: Do NOT zone out while a consultant is talking to you. You'll regret it as you won't be able to read half the things he wrote down. Imagine if I couldn't decipher what he wrote...the embarrassment I would have to go through as I would have to email him and tell him I can't read what he wrote when I should have been paying attention during the meeting.
Anyways I'm super stoked about my SSC in May! One more meeting and a bit of paperwork before my SSC will be official. Cannot wait.
Anyways enough with the weird banter paragraph above. Maybe I should put the beer away. Haha. If you guys read my last post carefully, I did not talk about Friday. No I didn't have lectures...and no I did not go into placement. Then you must assume I was skiving. No I wasn't skiving either...well I wouldn't consider it skiving because I was actually doing something productive. I had a meeting with an Orthopaedic consultant at the central hospital to discuss about my Student Selected Component (SSC) project for this coming May. The last time I met the consultant, I fell asleep in the chair and he had to wake me up...great first impression. Luckily it didn't really affect him as he was willing to see me again. He was actually quite keen to be my supervisor for my SSC and to mentor me. This time prior to meeting him, I made sure I was not going to fall asleep. I heard him come out from his office so I made sure I didn't look like I was dozing off...to be honest I was zoning out as all I did was stare at the wall. I had to wait for awhile as I was 30 minutes early for the meeting as I messed up on my travel timing so I was quite tired. Went into the office to discuss what I will be doing for my 6 week SSC project. We did a lot of brainstorming and came up with quite a few ideas. Either this consultant is smart or was prepared to discuss about my SSC as he was rapid firing ideas at me. Unfortunately, I kept zoning out as to be fair...I did not understand half the things he mentioned. He was talking about the different type of implants used in Orthopaedics, and obviously I have never heard of the brands. He talked to me like I knew all the brands so you could imagine I was very lost. When I get lost...I zone out. It's a horrible trait I have. As he went on, he realized he should write down what I will be doing. He set out a bunch of aims and wanted me to expand on it and give it a think. He filled up half a page with notes on the aims of my project (looking at implants). I quickly put the paper away in my bag without looking at the paper.
And then I perked up as the consultant mentioned that during my project he wants to do some clinical things with me. I told him that I got to observe a few trauma surgeries and paeds orthopaedic surgeries over the last few weeks. He ended up throwing a curve-ball at me and told me that it is good that I'm making the effort and be keen to go see these things, BUT the difference is that when I follow him I will be scrubbing in and actually assisting. Oh man, I got so excited it was ridiculous. I immediately sat up straight and couldn't stop smiling. Scrubbing in and assisting = music to my ears. Finally I get the chance to get my hands in and do something that I am interested in. He also went on how I will be able to do some stitching (heart sank a bit as the last time I learned stitching was a year ago). Now, I was very excited about my SSC and the consultant surely knows how to make a student happy.
After the meeting I quickly went home and took out the paper that he wrote on. To my demise, I could not make out half the things he wrote. I regretted zoning out and I should've remembered doctors do not write legibly. Took me ages to decipher what the consultant wrote. In the end, I figured out most of the things he wrote as I vaguely remembered the stuff he was talking about and managed to crack on with expanding on his notes. Note to self: Do NOT zone out while a consultant is talking to you. You'll regret it as you won't be able to read half the things he wrote down. Imagine if I couldn't decipher what he wrote...the embarrassment I would have to go through as I would have to email him and tell him I can't read what he wrote when I should have been paying attention during the meeting.
Anyways I'm super stoked about my SSC in May! One more meeting and a bit of paperwork before my SSC will be official. Cannot wait.
Saturday, February 4, 2012
Highlight of my Placement.
It is now the end of week 4 of my placement. 3 more weeks to go. To be honest...these last few weeks have been going by quite quickly. Even the doctors on the ward agree that these last few weeks have blown by. Now 4 weeks in....I'm really feeling a part of the team. We are all starting to get to know each other better so there's a lot more banter going on and joking around, which I really enjoy. Despite this, there are still a lot of up and downs during this placement. There are days where there's a lot going on, and then there are days where you start asking yourself why did you even come in.
Wednesday could have been easily the highlight day of my entire placement. This day also came at a perfect time as it's halfway into the placement and it really gave me a good boost. Every one noticed that I was in a very good mood on Wednesday and actually had a bit of spark in me. Found out that there was some paediatric surgery going on in the morning and I decided I needed a change of scenery. Heard the consultant surgeon apparently looks fairly stern (cue heart sinking) and no one could pronounce his name. Got changed into greens (oh I missed them soooooo much) and heard that surgery is delayed as the patient hasn't arrived yet. Sat in the coffee room and there was only one doctor in there (who looked kind of stern) and I figured he was the surgeon I will be following in the morning. It was fairly awkward in the room as we just sat in silence and watched a tv show. Few minutes later he got up and I shortly followed behind him and hope it didn't seem like I was stalking him. Saw the surgical list before going in and to my delight I found out he is a Paediatric Orthopaedic Surgeon. Pretty sure I was smiling like an idiot at the list. Walked into the anaesthetic room and we did introductions and after the consultant introduced himself, I knew immediately he's a really nice guy. He asked me to help him out with setting up equipment and he seemed really keen to get me involved. Slowly my mood was picking up and I was really getting excited. He then allowed me to scrub in for one his surgeries (in grown toe nail). It was a really quick surgery but when a consultant asks you to scrub in, it makes you feel involved and you start to feel more included/less useless. You feel like you're actually helping. It's a hard feeling to describe. Like during placement, especially early on, you feel unwanted and useless so when a doctor asks you to help even in a tiny little task, you get this good feeling/sense of satisfaction.
Anyways during a break in between surgeries, the consultant and I had a chat and he noticed that I seemed quite keen about surgery. It was cool having a casual chat with the surgeon and I told him I'm interested in orthopaedics. We had a really good talk about the specialty and then he told me to go to the Trauma list in the afternoon. Saw a fracture reduction + internal fixation and it was easily the bloodiest surgery I have ever seen, yet oddly enough, the one I enjoyed the most...ever. Even a few times I questioned myself as I caught myself smiling during surgery. I was really interested and I found the surgery pretty cool. There was a surgical trainee who was observing and he talked me through the surgery. The surgery was fairly complicated, but I was genuinely absorbing everything the trainee was saying. I was following along without difficulty and I just had this good feeling inside me. I think the hardest part about the surgery was wearing the lead aprons for 2.5 hours as there was a mobile xray machine in the room. Xrays were periodically taken to make sure the plate was in the right position and if the screws were placed properly. My back was killing me by the end of surgery (as I've been in surgery all day and almost all the procedures I had to wear a lead apron). But the aching legs and back was totally worth it. I could easily say it has been the best time I've had in surgery. The morning procedures were fairly simple, yet I still really enjoyed my time. It's quite weird.
"Be back by 4pm" said the registrar when I stopped by the ward to grab my bag for lunch. It was now 5:30pm and I was still in surgery watching the surgeon close up. He made stitching seem so effortless and simple, but I guess if you've been doing it for 20 something years, it'll become second nature. I was in no hurry to leave theatre. To be honest, I didn't want to leave. My bleep went off twice and I knew I should get going. The consultant and I had a chat after surgery and he said throughout the surgery he noticed me looking very interested/keen. I don't think I have ever really heard any doctor tell me I look keen. To be honest, most of the time I probably look like I'm not even there. The consultant also said he was fairly impressed that I didn't get sick as he agreed it was a very bloody/gruesome surgery. He asked when will I join him again in theatre or pop by his clinic as he said he wouldn't mind me around, especially if I'm interested in the specialty. Again I got this weird feeling of actually being wanted. Usually consultants don't want to deal with students, but this consultant seemed interested/keen to teach me.
Dragged my feet back to the ward and everyone was commenting how I look alive for once and happy. To be fair, I was very happy. I was definitely motivated. I can't wait to go back to theatre next week/hopefully I'll be able to escape to theatre. What a great day. Will never forget the last surgery of the day.
Wednesday could have been easily the highlight day of my entire placement. This day also came at a perfect time as it's halfway into the placement and it really gave me a good boost. Every one noticed that I was in a very good mood on Wednesday and actually had a bit of spark in me. Found out that there was some paediatric surgery going on in the morning and I decided I needed a change of scenery. Heard the consultant surgeon apparently looks fairly stern (cue heart sinking) and no one could pronounce his name. Got changed into greens (oh I missed them soooooo much) and heard that surgery is delayed as the patient hasn't arrived yet. Sat in the coffee room and there was only one doctor in there (who looked kind of stern) and I figured he was the surgeon I will be following in the morning. It was fairly awkward in the room as we just sat in silence and watched a tv show. Few minutes later he got up and I shortly followed behind him and hope it didn't seem like I was stalking him. Saw the surgical list before going in and to my delight I found out he is a Paediatric Orthopaedic Surgeon. Pretty sure I was smiling like an idiot at the list. Walked into the anaesthetic room and we did introductions and after the consultant introduced himself, I knew immediately he's a really nice guy. He asked me to help him out with setting up equipment and he seemed really keen to get me involved. Slowly my mood was picking up and I was really getting excited. He then allowed me to scrub in for one his surgeries (in grown toe nail). It was a really quick surgery but when a consultant asks you to scrub in, it makes you feel involved and you start to feel more included/less useless. You feel like you're actually helping. It's a hard feeling to describe. Like during placement, especially early on, you feel unwanted and useless so when a doctor asks you to help even in a tiny little task, you get this good feeling/sense of satisfaction.
Anyways during a break in between surgeries, the consultant and I had a chat and he noticed that I seemed quite keen about surgery. It was cool having a casual chat with the surgeon and I told him I'm interested in orthopaedics. We had a really good talk about the specialty and then he told me to go to the Trauma list in the afternoon. Saw a fracture reduction + internal fixation and it was easily the bloodiest surgery I have ever seen, yet oddly enough, the one I enjoyed the most...ever. Even a few times I questioned myself as I caught myself smiling during surgery. I was really interested and I found the surgery pretty cool. There was a surgical trainee who was observing and he talked me through the surgery. The surgery was fairly complicated, but I was genuinely absorbing everything the trainee was saying. I was following along without difficulty and I just had this good feeling inside me. I think the hardest part about the surgery was wearing the lead aprons for 2.5 hours as there was a mobile xray machine in the room. Xrays were periodically taken to make sure the plate was in the right position and if the screws were placed properly. My back was killing me by the end of surgery (as I've been in surgery all day and almost all the procedures I had to wear a lead apron). But the aching legs and back was totally worth it. I could easily say it has been the best time I've had in surgery. The morning procedures were fairly simple, yet I still really enjoyed my time. It's quite weird.
"Be back by 4pm" said the registrar when I stopped by the ward to grab my bag for lunch. It was now 5:30pm and I was still in surgery watching the surgeon close up. He made stitching seem so effortless and simple, but I guess if you've been doing it for 20 something years, it'll become second nature. I was in no hurry to leave theatre. To be honest, I didn't want to leave. My bleep went off twice and I knew I should get going. The consultant and I had a chat after surgery and he said throughout the surgery he noticed me looking very interested/keen. I don't think I have ever really heard any doctor tell me I look keen. To be honest, most of the time I probably look like I'm not even there. The consultant also said he was fairly impressed that I didn't get sick as he agreed it was a very bloody/gruesome surgery. He asked when will I join him again in theatre or pop by his clinic as he said he wouldn't mind me around, especially if I'm interested in the specialty. Again I got this weird feeling of actually being wanted. Usually consultants don't want to deal with students, but this consultant seemed interested/keen to teach me.
Dragged my feet back to the ward and everyone was commenting how I look alive for once and happy. To be fair, I was very happy. I was definitely motivated. I can't wait to go back to theatre next week/hopefully I'll be able to escape to theatre. What a great day. Will never forget the last surgery of the day.
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