Up at the more amenable hour of 0730, in for the board round at 0830. Followed the surgical ward round afterwards, which was pretty brief, before the surgeon mentioned the theatre list today and wondered if anyone wanted to go. After checking with the other two students on the round I headed back up to the theatre end of the hospital for another day in surgery!
The first two cases on the list were the same operation as one yesterday, however the approaches by the surgeons were radically different. Yesterday I'd had the chance to close on of the incisions with continuous sutures, and mentioned on the blog that I really wanted to practice subcuticular - then just like that today I got offered two opportunities in exactly the same situation! Amazing. First one the surgeon started off and I finished the incision, using a straight needle and very thin suture material. The stitches go just underneath the top layer of skin - it's quite tricky to get the balance between not poking out of the top of the skin but also not burying them too deep in the dermis. They run along the sides of the incision, and you alternate which side they go in with each stitch, so that when pulled tight the wound closes with no stitches visible = much better cosmetic result, with no puncture marks at either side of the scar. At the end there's a neat trick to tie of the knot and then bury it under the skin, good to learn. With the second case I had the chance to practice again, gradually started to get the hang of it. Felt more straightforward than the previous time I had tried on a post C-section woman!
Whislt I was concentrating on the surgical side there was an interesting anaesthetic event with one of the patients, where they had put a laryngeal mask airway in but on getting into theatre it wasn't working very well. This led to some problems which if left unsolved could have been really bad news for the patient - however it was quickly identified and rectified with some rocuronium (a muscle relaxant) and intubation with an endotracheal tube. Minor panic over! It's amazing though, as if you weren't really paying attention you wouldn't have realised anything was wrong - the anaesthetic team were so cool. Very little phases anaesthetists, and in this case even though it had potential to be very serious everyone managed it in such a calm way that I barely realised anything had happened! One of the things I really like about anaesthetics, the ability to be calm under pressure.
Coffee break and some food, then onward with the theatre list. This is one aspect of theatre's I really like, having intense well defined periods of activity, interspersed with chill out breaks where everyone involved gets the chance to sit down for a few minutes, have a brew and get to know each other. There's rarely a time on the ward when everyone is free at the same time for a quick break, it just doesn't happen. In theatres though you have these discrete periods of time where you can totally relax, before the next case starts and you have to get your game face on and concentrate. I like it, and the day absolutely flies by!
There were a few minor procedures on the list before the last big one, another laparoscopic cholecystectomy! I was cameraman, manouevering the camera around in the abdomen whilst the surgeon was using the instruments to perform the operation. Incidently after scrubbing in for this I spent 20 minutes with the scrub nurse, who kindly took me through all the instruments on the trolley. Everything has eponymous names - Langenbecks, Cockers, Babcocks etc. Getting to know them is a bit of a challenge! There was a really awesome bit in this operation where, using the tiny laparoscopic instruments, the surgeon cut halfway through the bile duct and then threaded a tube into it, all to inject contrast and take an xray of the draining system. It's quite hard to appreciate what happened without seeing it, I've tried to think of an analogy to explain it but can't! Very impressive in reality though, especially when done at speed. After the operation was done I got the chance to suture up again, this time using subcuticular horizontal mattress sutures to close up the small ports - another new stitching technique for me! Learnt so much in theatres this week, been a really good experience working with different surgeons and having the opportunities to practice a bit of suturing. I'm seriously considering surgery now as an option, more so than in the past. Will have to start looking into it once back in London.
After the list was finished I went back onto the wards, when walking down the corridor I spotted a patient I'd seen in the first week but had been discharged - now they were back! Had a quick chat and then read his admission notes - same reason for admission this time as last. Hopefully we'll be able to forge a more lengthy solution this time round. With it being a Thursday the evening tutorial was conducted at Cobbs after home time. Good chance to unwind and discuss the day, and later on be regailed with outrageous stories of Belford-ians past. Quick Morrisons trip then home, dinner and chill. Rhod Gilbert work experience on TV, attemptimg to be a scout leader for a weekend camp - very amusing! Great day, great week so far, only got one more to go after tomorrow!
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