Monday, 22 March 2010
A failed vampire
So now I am on surgery... Stop reading now if you are eating or about to have dinner ;)
For the last three weeks and remainder of this week I have been on GI surgery, I have quickly learnt that this is a strange area of medicine where patients go if they have abdominal pain and/or poo problems. Whilst asking patients how their bowels are working is a common question in all areas of medicine, GI surgeons really like to concentrate on it, if you forget to ask exactly when a patient had their last bowel movement and its errr consistency (I did tell you to stop eating!) then you haven't taken a history fully. I've become quite blase remarkably quickly about asking patients about such an intimate area of their lives, to start with though I can't deny I found it a bit embarrassing to ask someone that and even caught myself once refering to stools as "Number two's".... Opps!
Despite the strange basis of this speciality and the fact I am really not interested in becoming a surgeon (which with my perfected combo of clumsiness and cackhandedness is definately a good thing as far as patient care is concerned!) I am actually really enjoying being a student in this area. My team on my current firm is great - the junior doctors are all really lovely and happy to teach us during their breaks (the F1's happily tell us you get quite a lot of breaks as a surgery F1 which means you can eat all the mess food before the medic F1's get there!) so I'm learning quite a lot. Furthermore as its surgery we get to do some of the cool practical stuff that you always look forward to doing in your pre clinical years. Last tuesday by a case of being in the right place at the right time and having randomly mentioned to an F2 who was on call that I really wanted to have a chance to scrub up for an operation (we've been taught how to but I hadn't put it into practice yet) I got the awesome opportunity of assisting with an open appendictomy. How cool is that!! The F2 got bleeped and asked to come help assist because the assistant surgeon had to leave but because she was on call and too busy clerking in all the new patients she suggested to the registrar who bleeped her that I could assist instead :D. A kind anaesthetist helped me remember how to scrub in and before I knew it I was there retracting bits of bowel and holding someones appendix. The operation took quite a long time as it wasn't a typical appendictomy as the appendix was quite hidden (which is why it ended up being an open operation - it was attempted using keyhole first of all but it wasn't going to work) and I was starting to feel quite faint near the end due to the heat in the theatre and the constant standing up, as it was only the theatre nurse, the surgeon and me scrubbed in I was starting to worry what would happen if I reached a point where I was going to faint or have to sit down as I wasn't sure who would retract whilst someone else was scrubbing in to replace me (it takes over 5mins to scrub in). Fortunately it didn't come to that so my first attempt at assisting in surgery did not become a complete disaster!
Whilst this is the only operation I've assisted in I've been able to see quite a few others - a hernia repair, a gallbladder removal and three appendictomys. Ive also seen a colonoscopy (a camera up your back passage as the surgeons describe it) and an endoscopy (same but down your throat for the upper end). Today in clinc I see (and look down) a sigmoidoscopy (similar to colonoscopy but doesn't go so far and the surgeon looks down rather than looks on the screen at the images transmitted from the camera) and see haemorroids (aka piles) being banded. So theres been lots to see which has been cool and I've also had lots of on takes (including one 8am-10pm one - eek) so have also got to and clerk in lots of patients by myself which is always great practise.
Another skill I have been able to practice whilst on GI is taking blood. This is something we are meant to try an practise as much as possible but unfortunately despite regulary voluntering to take blood I have so far only got the chance to try on one patient right back on my very first rotation (an attempt that was only successful with a little help from the reg who was with me). Due to this and my aforementioned cackhandedness I am rubbish at this... During this rotation I have had the chance to try on three patients so far...and have succeded to get 1 measley tube out of all of them combined :S. My first attempt was on a patient who was about my age and absolutely lovely to be despite the fact I stabbed her with a needle on an area that was already covered in bruises from blood tests and failed to get any blood whatsoever. In my defence in this case she did have tiny veins and the bruising made it impossible to see them so even the F1 struggled a bit. But she told me I really didn't hurt her and was generally lovely. I later found out that she was considering medicine as a career so perhaps that is why she was so understanding. My second patient was on someone who have enormous veins so there was no excuse for missing in him, I did get the vein and successfully got one tube of blood but unfortuanately in trying to switch for the second tube (the tubes are vaccum sealed so have to be pushed on with quite a bit of force to break the seal) the needle must of moved within and no blood filled this one; I tried to adjust the needle position slightly as sometimes this helps but I pulled the needle out to far and heard the hiss of air caused by the tubes vaccum being ruined as the needle leaves the skin and so air enters. Then not thinking I pulled the needle out fully whilst the tourniqet was still on the patients arm.... This means the blood is still under a lot of pressure and so causes blood to come out rapidly which never looks to great from a patients perspective.... My third patient I was never going to have much luck with - a very elderly patient who had been in hospital a long time which means lots of his veins had become unusable, leaving no easy vein options. Predictably I completely failed on this one.
So yes, glad I am not a vampire! Ah well practise practise I will keep trying, sooner or later surely I will hit that red gold!