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Care of the Surgical Patient – Week 2

Tuesday

Thankfully had the Monday off due to the bank holiday. Much needed as I was exhausted most of the Sunday so caught up on nothing ….

I had my first bedside teaching session with Mr O which I was a tad nervous for but I could cope without my crutches for the morning which was an improvement.

We saw a couple of patients across a couple of different wards. I keep forgetting to take my goggles out of my bag, so I ended up wearing one of those annoying visors for it all. We focused on History taking and examinations in context of the level of a final year. This was terrifying, but it is the sad fact now that technically, I am in my final months of medical school. In a way it’s kicked me into motion as I feel like I am learning things that are going to help patients and me in the long run, and not just for an exam

It was a great two hours, and we ended up in a deep discussion about the gallbladder and biliary tree (as you do). We also ended up chatting about Australia as it’s a place I would like to go to some day, maybe to work, maybe just to holiday. We also ended up chatting about vascular surgery and emergencies he had worked on in the past, and I was in awe.

Even though my hip was on fire, I actually really enjoyed this time spent. It’s not often we get to sit down (OK, in this case stand) with our consultants and have chats like these, so I was grateful for the extensive teaching and just the ability to sit down and have a chat.

In the afternoon we had a tutorial on the thyroid. Now, endocrine is not my strong point, I get muddled what causes hyperthyroid and what causes hypothyroid, don’t even get me started on anything else.

However, in the two and a half hour tutorial we had, I did not zone out once. No PowerPoint insight but I got the most out of a teaching session I had ever had. It was in the form of a general discussion and with a paediatric surgeon (so God in my eyes) and I learnt so much. Granted, I am writing this two weeks later and still haven’t had a chance to re-visit my notes but I came out of that session a lot more confident.

I am loving the teaching we are getting at the moment. I feel so much more supported than I did last year when we were essentially left to get on with it. The only downside is that we have so much teaching, it’s hard to sneak in to surgery. You then add the addition of the second years and the Bucks students, and we realized we have three sessions of theatre for a 5-week block in theatre. One of the draw backs of a small hospital I suppose!

Wednesday

I was scheduled to be in for the afternoon for theatre but ended up moving to the morning and had the best morning ever. Sure, anal fissures and colostomy reversals aren’t glamorous but I have found myself getting into colorectal. Huh, maybe instead of Neurosurgery I am destined for the other end of the human body.

I had a great surgeon who not only responded to my email in 5 minutes on the same day, but was also great for teaching. There was a fairly simple operation to begin with so I hovered around and mainly helped with the anaesthetists. I got to perform my first jaw thrust (100% easier on a human than a manikin) and got to see the induction of surgery and was soo close to inserting a ET tube but panicked at the last second because I was too afraid of knocking teeth out….

The second case will be a case that sticks in my memory as it was the first time I scrubbed into a surgery.

I have been waiting for this day for THREE YEARS. THREE YEARS. I enjoyed it so much. The nurses help me scrub in as it was my first time and I managed to stab the inside of my nails cleaning them out too hard, but I didn’t care. I was there, standing at the table touching the patient which felt sort of illegal.

I got to see the operation up close, and the team found something for me to do. OK, it was very much slowing things down for them, but I got to clip the end of the sutures (which is something the scrub nurse normally does, but they were so lovely getting me involved). It was amazing to see the detail of anatomy I last encountered in first year and at the end the main surgeon scrubbed out, and I got to stand in their place helping to cut the end off the sutures. I also got to inject sub-cut local anaesthetic, and place the bandages.

I was beaming (and very grateful to take off the gowns) at the end and I ate lunch on a high.

As, I was meant to be in surgery anyway in the afternoon I thought I would try my luck and attend the anaesthetic side with our years DST. It was the first time we had actually met in person which felt strange! I really enjoyed this and we talked though the purpose of each medication and discussed the new technique of surgery where everything goes into the IV and nothing ventilated.

I also got to place my first IGel and I sat chatting with the trainee about their experience of anaesthetics. I have considered aesthetics, aligned with surgery, it is the sort of environment I wanted to be in, but I am not completely sold on it yet. I like the idea of being involved with ICU and paeds but, I don’t know. I want something more fast-paced, but I like the lifestyle and knowing where you need to be and what is roughly going to happen each day.

I ended up going home that night exhausted but- it was such a good day.

Thursday

We had some further teaching on Thursday morning with the surgeon I had yesterday. Despite starting at 10. K and I found ourselves killing the first hour in the education building as we have to get in early for parking. Ironically, they have taken away 100 odd spaces to building more car parking. Great in the long term but a pain if you have a weirdly timed teaching session.

It was nice to catch up with K though, I really do miss our lunches together.

It was another general discussion session again, so I gained a lot out of it. We talked about chrons and followed through a pretend patient from first presentation to tertiary treatment. You can tell which sessions I tend to get the most out of because my writing is literally everywhere, and I tend to come out with ink all over my hands…

In the afternoon, we had another Simulation session. I had led the week before so this week I decided to get some prescribing practise in. If you aren’t the helper or the official prescriber, it is easy to drift off in these sessions and gone are the days when drifting off was OK.

Instead, I listen to what is going on and practise prescribing on a fake prescription sheet, This helps for the PSA I will take next year and for getting used to the BNF. I am slowly getting used to this, it’s going to take practise, a lot of practise and part of me wishes we had done some earlier in the course but oh well.

In the evening we had a fantastic Women in Surgery event which I attended online. Surgery is VERY male dominated, and it’s easy to see why. However, the surgeons on this talk were awe-inspiring. It was with all grades of trainees from us medical students all the way to ST7 and common questions were balancing training with kids, and time management. My favourite tip was – if I can pay someone £20 a week to clean my house, so I don’t have to, then I am paying someone £20 a week and that’s two more hours I get to do what I want with.

One talk stuck with me a lot more which was basically saying “Stuff being a woman in surgery, you are not a woman in surgery, you are a surgical trainee, that’s it, see yourself as equal to your peers, and you will succeed….

I currently am sorting out a day’s observation with this surgeon when I get a spare moment.

Friday

Really starting to feel the tiredness now, however, no rest for the wicked and medical strudents.

I was in Stratford today which is somewhere I was for first year, so it was like coming back to an old friend. I had a clinic with Mr O in the morning, so I was looking forward to it. Of course, I was looking forward to it. Despite it only being a 20 min earlier exit than usual, I treated myself to a McDonald’s which was only round the corner from the hospital….. a bit ironic really.

I arrived at the clinic and seemed to have forgotten the big thing with clinics. The ‘no patients” bit. I did get to see two people though (which apparently is rare) and got to see haemorrhoid ligation (actually pretty cool) and talked through referrals from the screening programme and GP (IRON DEFICIENCY ANAEMIA).

Honestly, I have loved having Mr O as my consultant.

I then spent the afternoon having a wander round beautiful Stratford. Well, I was there, so it was a no-brainer really. It is so, so beautiful !

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Care of Surgical Patient Week 1

I’m going to level with you here, I was not expecting much from this block at all. Surgeons and surgery have this expectation attached to them that you are going to be ignored mostly for the block and spend five weeks in the corner staring at people moving their hands around. For once, I am so glad to be so far from being right.

Monday

New block, new me. And this time also a new hospital. Warwick hospital is the one hospital attached to the medical school that I have yet to see. And we were finally here for surgery block. Monday was just a day of inductions but K and I had decided to drive there the week before just to get to know where we need to be heading.

I arrived at the hospital and began to walk from the car park to the medical education centre which involves me walking through the hospital as I didn’t know any other way. Over at George Elliot all they have boxes of masks at each entrance, and it means that all staff and visitors have no excuse for not wearing a mask. So, I had turned up expecting this.

Warwick has decided to not do it this way. Great for budgets, not so great for me. I had to walk through half the hospital with no mask on as I didn’t have one in my pocket. It just so happened it was the busiest I’ve ever seen a hospital corridor, and I’ve got so many dirty looks. Thankfully, I managed to grab one from the canteen halfway up the corridor.

After that dilemma I made it to the medical education building and I had to sneak in behind someone as I didn’t have an ID card for the door yet. You can see how this morning is going.

Anyway we get there, and I managed to find a room and I set myself up for the day. Our first lecture was virtual, and it was just getting to know the clinical education fellow he was going to look after us for the five weeks of a surgical block. It was very weird all being on a virtual lecture, but all sat in the same room.

Thankfully, our second lecture was a face-to-face, and we had a formal induction to surgery at Warwick hospital. I know my blog is looked at and read by a good few number of people, but I never expected to get recognized. So, I was a bit lost for words when we had to introduce ourselves and the person running the session said ” no need Abbie I know you’re off Twitter”.

I do this weird thing in my brain where I forget that people on Twitter also real in real life, and it always takes me back when someone mentions what I’ve done on Twitter in reality. It was a laugh though, and I guess it’s just made me remember that real humans read my tweets.

We didn’t have too much information given to us before we arrived at Warwick, so on this day I was just a Fountain of questions and wanting to know everything about surgical block before we got started. I have to say this hospital was amazing and I got every single question answered.

We had a tour of the wards that we would be going on, and we got told exactly what time we should be there every morning, where the changing rooms were, where the best places were to get a free cup of tea or coffee, and what areas were green and amber which is a unique addition to life in Covid land.

I’d start the day with 25% hope this block, I left with 95%.

That day we also got retested for our Covid masks as I didn’t particularly trust the one that I was tested for at a previous hospital. We got to use the less scientific version at Warwick which basically involves you tasting a spray that they spray into a hazmat suit type headgear, and you do some weird movements just to see if the mask lets any of the particles in.

Going home that day felt weird. K now owns a car so we no longer travel in together as where we live it doesn’t make sense for us to drive to each other’s houses. So I got in the car, and normally we have a bit of an informal debrief at the end of the day joking and discussing what we have seen.

I know I didn’t have that and I was very aware of the empty seat next to me. Honestly, it feels like he has died 😀 . It does mean however, I can blast my musical songs out loud and have no judgement put upon me.

Tuesday

Slightly earlier start today with it being 8:30 rather than 9 o’clock. I still haven’t managed to figure out the new timings from my house to Warwick hospital so inevitably I was running late.

We had wound care teaching which was basically going over how we would assess and re-dress a wound. I am a total popaholic and nothing is more satisfying than seeing a big wound be absolutely drained of all the puss that’s in it.

We also were taught how to do flu swabs which is very current with the bug that’s flying around. It was a long morning as most of it was just being talked at, but at the end we had to demonstrate that we knew what we were doing and we were all passed with flying colours.

Everyone else decided to go home after that, but I found that I haven’t been working as well in my flat then I should be, so I decided to stay on at Warwick and go and work in the rain that we had been given for lunch.

This also meant that I was going to stay for the virtual lecture that we had in the afternoon about stomas and polyps. Which was both a mistake and the best thing I’ve ever done. I was expecting to be sat on teams watching someone talk us through a camera, can imagine my shock when the surgeon who was teaching us walks in the room that we had been assigned and there’s only me there.

However, the surgeon was the surgeon that I’d been assigned to, and it was actually one of the best teaching sessions I have ever sat in. Sort of intimidating when no one answers the question online, so you feel obliged to, but we struggle on.

This was also the day when I realized Warwick surgeons are amazing. My assigned consultant brought up the fact he would sort bedside teaching and OSLERS with K tomorrow, without me having to bring it up. I think I nearly fell over, I’m so used to chasing people up for WEEKS. I still have a ticket from year 2 unsigned.

He also had a Harry Potter lunch box, 100 points to Gryffindor.

Wednesday

My first day of clarking. i have never clarked a patient before despite being in third year. This was something I was more than keen to change. I was assigned to the sorting hat ward for the day and, yes, I was a changed Medical student after.

I will never forget my first patient. I was nervous, stuffed up my ECG and couldn’t find a vein. But it was OK, I had not done an ECG in MONTHS and had completely forgotten where the pads go. However, I loved chatting with the patient, finding out what was wrong and escalating to the reg. It felt like all the studying and ridiculous amounts of work were paying off.

One of my patients was admitted and was unfortunately given a heavy diagnosis, but I had gotten on well with them on the ward and I knew it was going to be nice to follow up this patient through his journey at the hospital.

I was exhausted by the end of the day but so happy. Finally, being able to interact with patients and chat to them and do what I have been trained to do. That is what the pandemic took away from us and still takes away from us today.

Thursday

That morning I joined the post take ward round which started at 8am (ouch). This would give me the chance to A) find out what a post take ward round was and B) see the progress of the patients I clarked yesterday.

I was amazed at the progress of one of my patients. It is amazing what a simple bag (or a couple of bags) of fluid can do! They were severely dehydrated when they came in so seeing their progress was incredible.

I also helped the F1 out by managing the notes, so they were not juggling millions of files. It’s not much but kept me going whilst we saw the million and one other patients I had never met before.

In the afternoon, we had our simulation session. I love simulation as it gets us to practise as if we were independent FY1’s instead of med students shuffling round the back of the ward round. It was also a session to catch up with each other as our weeks are so busy now, I don’t even get to see K.

That’s another thing the pandemic has taken away. The chance to see others and catch up. There are some of my friends that I haven’t seen in over a year.

We ran several simulations of surgical emergencies that come into A&E. I volunteered to lead one which resulted in a diagnosis of acute gallstone pancreatitis. I really enjoyed it but I learnt that I need to slow down. Too easily I slip into recalling my notes and not taking head of the situation and asking for help, simply because, I forget I can ask for help.

That evening I was also struggling with a chronic hip problem. So, I had hobbled back to the car and by some miracle managed to get an appointment the next day.

Friday

In early again for endoscopy this time! I was intrigued as it’s something we are told about all the time but never see. I was with my consultant again so I knew it would be a productive morning. I got to see a vast array of different signs and this is going to sound really weird, but the inside of the ileum (the last part of the small intestine), is beautiful.

Jejuno and Ileum Normal -The Gastrointestinal Atlas -  gastrointestinalatlas.com
This is an image from Google but shows the villi which look like sea anenomy.

The teaching I got was incredible as well. I am not sure what it is about third year but suddenly, I feel like I have a place on the ward and people like having us there. They want to teach us and get involved. This is what I am here for.

I had to get big scrubs to cover my hip brace, so I ended up having to yank the trousers up every two minutes.

Saturday

Yes, I am slightly questioning why I am up for an 8am handover on a Saturday but we were scheduled to follow the SHO for the on call. This is essentially where any department can bleep the SHO (mainly ends up being A&E) for a surgical review and the SHO can decide if they need to be admitted or reviewed by a senior clinician or discharged.

I was also getting used to my new additions. I was given some crutches by the physio as the pain from the hip is ridiculous, but these were getting very annoying very quickly. They hurt my hand and basically signalled I was going to be a slight inconvenience. However, I need them. Hopefully, I can just rest my leg for the week and might not need the assistance in a weeks time.

Around mid-day I lost my SHO and wandered back to the ward and ended up finishing the ward round. It sort of came to an anticlimactic end, and I was left hovering round the ward not sure what to do. However, I got wind of a cholecystectomy happening in the afternoon and decided to hang around for that.

I went down to the amber theatres and waited. Turns out it was not going to be happening for at least the next three hours so I thought I would sneak in and watch a nail being inserted into the bone whilst I waited. The team were all really lovely making sure I was catered for with my leg and I was having a good old chat with the rep for the system they were using getting to know all the instruments and what they were there for.

I was also having a good old giggle with myself as being an orthopaedic surgery, they had literal drills to get the screws in. Something I am normally used to seeing in my dads tool kit.

Finally, at 6pm the time came for the operation I had hung around to see. Except this time it was an appendectomy rather than the cholecystectomy. I was so glad I waited. This appendix needed out and was nearly falling apart as they handled it. I was also having a discussion with the anaesthetist about the agents they used and what each drug does. We don’t get a huge amount of teaching with peri-op so I wanted to make sure I had a good idea about what was going on.

Happy, I had finally wiggled my into theatres.

I eventually escaped at 8pm promptly ordering a pizza on my way home. Well, I did go in on a Saturday after all!