Tales from the OR

So suffice to say this blog hasn't exactly taken off. In this respect I fear it will go the way of my previous attempts at blogging - a couple of sporadic entries, then lost forever in cyberspace. Nevertheless, the last 6 weeks of my life have provided a steep learning curve, which I think are worthwhile documenting.

I've been attached to two surgical teams, for 4-week blocks each. Being a medical student on a surgical team typically consists of 50% being a nuisance, and 50% retracting. Retracting is when you stand there in the Operating Room (OR), literally holding in place a retractor that exposes a patient's surgical incision by pulling the skin and tissues apart, in order to provide a wide field of vision for the surgeon. If you bug people (i.e. the registrars) enough, though, you can learn some handy skills in a surgery term, and I've (sorta) learned how to insert urinary catheters in males and females, interrupted suturing, stapel closure, and a few other tidbits.

Learning to scrub is one of the first big rites of passage for med students on a surgical rotation. It's a famously nuanced procedure, and the maintenance of sterility in the OR (entrusted to the feared scrub nurse) is worth a blog post on its own. The first surgery I had to scrub for was a femoral-popliteal bypass graft (this is a surgery which creates a "bypass" through an obstructed artery in the leg, to restore blood flow) - I walked in an hour late (because I had a class), and the surgeon was not impressed. Luckily, the intern - who is fantastic and made the term so much smoother - covered for me.

I've done some night shifts, and scrubbed in on a 3 a.m appendicectomy (i.e. surgical removal of the appendix, for appendicitis), and a 5 a.m neck exploration and debridement after a trauma - the guy came in after being smashed in the neck with a beer bottle stump. It was quite surreal, the surgeon was literally picking out bits and pieces of glass from the patient's neck, including a large shard that had half the beer's brand imprinted on it! Both patients were fine.

I'm surprised by how well I've managed to handle the early morning starts (I've got to wake up at 5:30 am Monday to Friday!), and late finishes - but I don't think I could do it my whole life. Overally, I think I've developed a healthier respect for surgery than I had beforehand. While I have met some particularly nasty, lascivious, misogynistic surgeons, there are physicians out there like that too.

What's really struck me these last few weeks is how damn useful surgical skills are - I've always wanted to do work in developing countries, and surgery is so convenient for that: it requires minimal knowledge of the local language, and, boob jobs and botox aside, it really is life-saving stuff. And then there's the "quick fix" factor, that every surgeon will rave on about - with surgery, you can cure a patient's problem right then and there, whereas other specialties are much more tortuous in their therapeutics. But on the other hand, surgical training is such a long haul, the culture so alpha-male, the hours very family-unfriendly...and most of all, much less contact with patients than I would like.

So I'm still leaning towards paediatrics, which I think is a fantastic mix of medicine and behavioural psych, and has an insanely friendly professional culture - I think this is because paediatricians are very patient teachers, since patience is so essential to working with children. And it's so easy to stay motivated and focussed when working with kids, too, which is another reason I'm attracted to it.

So what I'm looking for now, is a way to do paediatrics and get some hands-on experience with basic surgery - in particular, laparotomy (incision of the abdomen, to perform emergency operations on the appendix, gall bladder, intestines etc), caesarean sections, and fracture treatment. I'd really like to be able to handle basic surgical emergencies if I'm stuck on my own in some godforsaken corner of the globe with minimal facilities.

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On another note, I should probably say something about Michael Jackson. I learnt about his death by SMS while I was at hospital, rushing between wards, so while it was at the back of my mind the whole day, the fact didn't really sink till later, when I was driving home and heard I want you back playing in the background of a news story on the death. Then I sorta felt gutted; it was as though I knew in that instant that the song would never sound the same again. As much as I am chilled by some of the things MJ is alleged to have done later in his life, I grew up on his music in the early '90s. He defined cool in those days. I remember standing in front of the TV as a 5-year old, eyes glued to the screen, syncronously throwing my hat away with him so I could be cool too. That's the MJ I'd like to remember.

nil desperandum,
Treasonably Reasonable

"Take physic, pomp..."

"...Expose thyself to feel what wretches feel..." - William Shakespeare, King Lear, III(iv), 32-33

A patient once called me a vampire. MK - not even close to his real name - had reasonably assumed that I'd come to take his blood. To stab him in the cubital fossa with a 21-gauge needle and slowly suck out his sanguinity, like someone else had done the day before, and the day before that. He was joking, of course; despite all the humours drained from his sickly 80-something-year-old body, MK had heroically retained a sharp and snappy sense of humour.

He was something of a poet, and in his spare time - of which there is plenty when you're stuck in hospital - he gave his biro a good workout, and was always happy to share the fruits of his labour with the treating team. One of his poems was about about the anonymity of the hospital experience: the whirling in and out of interns, residents, staff specialists, nurses, physiotherapists, occupational therapists, dieticians et al, a wealth of assorted names and faces, people you'll meet once then never hear from again.

All medical students are vampires. Trawling from ward to ward, pouncing on the patient with the rare murmur, the ghastly ulcer, the classic history. And with the predictability of the vampire emerging from his coffin home at night, come exam time we would file into the wards and pester doctors and nurses for all the "good cases", as though our careers depended on it.

There is not much 'therapeutic' that a medical student can offer to patients on a day-to-day basis, though one tool we do all have is the healing power of listening. In many ways, listening - I mean really listening, measuring every word, blocking everything out of your mind and immersing yourself in the patient's suffering so you can the see as they see, feel as they feel, even for just a moment - is the best way to say "thank you" to the patient who has been good enough to give you their time, their story. And often, it's the only way.

nil disperandum,
Treasonably Reasonable