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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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