Hand Surgery

So day 2 of hand surgery is down.
It seems that I will need to start at 7:30am everyday and generally finish after 5pm.
So far, I"ve spent a day in clinic and a day in the operating theatre.

The day in clinic consists of me measuring grip strength, joint angles and pinch (apposition?) strength while the consultant drills me with questions.

The day in the operating theatre consisted of me standing around.
Well, until the last case which was a radial nerve repair. Seems that the orthopods that put a plate in for the fractured humerus got the radial nerve caught under a screw, so it had to be repaired with a graft.
I got to stand around but also take photos using the consultants flash camera (Olympus E-1 I think it was). That was fun. Sort of.

I"m tired of it already...

Where did this come from? Oh yeah...

A month without making a blog post? That doesn"t sound like m- oh wait.

It totally does.

I blame the surgical careers evening.

Anyway, where was I?

Oh yes, I was blogging.

I am blogging.


This is pretty much the worst blog post ever.

A few topics to discuss in summarised form:
1. The past month.
2. The next month.
3. Exams.

So anyway, its been a vaguely interesting month.

3 weeks on the respiratory ward flew by pretty quickly as I managed to see a certain respiratory consultant as little as possible while trying to be as productive as possible in order to gain the marks on my in progress training report. Not that it mattered as the registrar left in the middle of the week leaving me to get my ITPR done by the new reg. Such wasted effort.
Saw some interesting cases, the highlight probably the tuberculosis patient with zero clinical findings. So that sort of outlines how exciting respiratory was...

The week on cardiac care was... Yeah. So we just throw 5 drugs at people and let them go home with varying amounts of work leave. Exciting. Saw an angio done though and a stent inserted. Wanted to see the "full metal jacket" stenting but decided it just wasn"t worth standing around for.

Now though, I"m on the AMU! The newly constructed acute medical unit is all shiny and white and has lots of short stay patients that I can pretty much just ignore continuity of care because they get dished out elsewhere within 48 hours! Yay!
We"ll see how excited I am with 3 more weeks of AMU though.


Exams in 4 weeks. Getting nervous. There isn"t much more to say on that...


Oh, and I thought this was a fun, valid plan for OSCE stations:

Surgical Careers Evening

Nope, still don"t want to be a surgeon.


Food was good though.

On things to come...

Because everybody else is doing it, I thought I might as well too.

So most people in my year have just found out their rotations (well, "just" being 2 days ago) but I"ve been one of the totally lucky ones who knew over a week ago. I was one of many who was left with a missing term 1 due to the totally fair and perfect algorithm the magical School of Medicine computer uses to allocation rotations. Working fast, I managed to get what I thought was the best of the worst, but others were not so lucky. My heart weeps for the two people who had to do Chronic Condition Self Management, and my Respected Associate who had to do Neurological Rehabilitation.

Outlined below is what I like to call (for the first time) The Grand Plan:

Term 1: Musculoskeletal Rehabilitation
Location: Repatriation General Hospital
Probable job description: Fractured hips, femurs (heads, necks) and knee replacements I should think.
Personal thoughts: Could be hit or miss but its ok, I have company for this term and we"ll make the most of it. *sigh* At least the year can only get better...
Career opportunities: Physiotherapist, Masseuse

Term 2: Urban (Legend) General Practice
Location: My new favourite GP's practice. 
Probable job description: Being Awesome!
Personal thoughts: Very excited about this one, I"ve been having my GP placement here and from previous posts, you can probably tell I enjoy it very much.
Career opportunities: GP, Batman

Term 3: Critical Care Medicine
Location: Flinders Medical Centre Intensive Care Unit
Probable job description: Watching and waiting. Then waiting more. Also watching. 
Personal thoughts: Should get some good physiology and medicine knowledge here. Maybe do some management things.
Career opportunities: Intensive Care Specialist, Dr Robert Chase

Term 4: Emergency Medicine
Location: Flinders Medical Centre Emergency Department
Probable job description: Running around like a headless chicken.
Personal thoughts: If rotation quality was proportional to number of people wanting to do it, this would probably be the best rotation ever. It should hopefully be exciting. Alternatively, this could be so much work I might lose my mind. We"ll see.
Career opportunities: Alcoholic, George Clooney

Term 5: Unconfirmed
Location: Hopefully, Singapore General Hospital
Probable job description: Messenger boy
Personal thoughts: Hopefully I"ll be doing anaesthetics and general surgery.
Career opportunities: National Service, Ending sentences with "la"... la.

Term 6: Cambodia
Location: National Pediatric Hospital
Probable job description: Picking on little kids, stealing pocket money, etc.
Personal thoughts: This one should be fun! I like paediatrics :)
Career opportunities: Paediatrician, Nobel Peace Prize Laureate

Term 7: Vacation
Location: Asia
Probable job description: Being on holiday
Personal thoughts: This will be a lot of fun, aiming to go to China, Hong Kong, Taiwan and Japan.
Career opportunities: Dumpling King, Communist

Term 8: General Surgery
Location: Mt Gambier
Probable job description: Generally surgerising. Some surgery on generals?
Personal thoughts: Surgery is the topic I"m least excited about, but who knows, rural general surgery may be more exciting than urban general surgery (which consists of hernia, hernia, laparoscopic cholecystectomy, hernia, colonoscopy, colonoscopy, colonoscopy, colonoscopy, endoscopy, endoscopy AND colonoscopy).
Career opportunities: Obnoxious Pretentious Twat Surgeon

There we go. The plan is out.

So who"s excited?

Wolfhounds

I spent all of Tuesday and this morning dealing with eyes.
Tuesday morning was spent in a regular eye clinic, which seemed to mostly involve people who had cataracts and wanted to get rid of them, or people who had previously had cataracts and had gotten rid of them.
Tuesday afternoon was spent in eye theatre, which involved people who had cataracts and was in the process of getting rid of them.
So yeah, I saw the whole spectrum of a day in the life of a cataract.

Today was slightly more interesting as I was in an eye emergency clinic. There were patients presenting with a range from common normal age related problems such as posterior vitreous detachment and entropions to less common problems such as symblepharons and autoimmune iritis/uveitis to environmentally caused problems like foreign bodies and attacks by Irish Wolfhounds.

That"s right. This patient had asked the owners if it was safe to pat and got the affirmative. Bent down (this person was very tall) to give a pat and the dog lunged, bumping the person"s forehead with its nose and managing to get a tooth on the bottom eye lid. Luckily, no real damage apart from a bit of scarring that may cause irritation.

Gotta love the interesting stories that arise in medicine.

Paediatrics

Looks like I"m falling back into my poor blogging habits... Gotta get on top of that.

So I"ve just started paediatrics.
First day down and I"m quite liking the fact that paediatrics is so organised.
Surgery was a poorly organised and poorly maintained rotation in my opinion. Sure, the coordinator is very nice, but as stated by another surgeon "JW needs to learn to email and stop living in the 70s".
We"ve got plenty of teaching sessions in paediatrics and the first day was buffed with introduction to history taking and examination in the paediatric patient, as well as community health. Both lectures were quite interesting and very relevant.

Anyway, I should probably go get ready. I don"t want to be late on my second day!

A tasty day.

Today started as any other, with my rising before the sun. I was annoyed, but that was usual. I was actually annoyed slightly less today as I knew there would be a group meeting with FREE BREAKFAST!

I cheerfully arrived at ward rounds, right on time and eagerly awaiting breakfast. I knew we could fly through the 4 patients we had in a flash and move on. Unfortunately, we managed to acquire 4 more patients overnight. I really can"t complain as everyone else I know of seems to have 20+ patients on their wards. Oh well.
That"s when the Registrar started playing with my emotions. He told us there wasn"t a meeting today.
My fellow students and I cried. Or at least, we were greatly disappointed.
After dragging ourselves through ward rounds, taking our time, our resident super nurse told us that we should be getting to the meeting. My eyes lit up, there was indeed a meeting today! My Registrar was wrong!

30 minutes later, I was satisfied (though not as much as I could be, there were bacon and egg wraps last week!) with mini pancakes, muffins, strawberries and yogurt. It was time for theatre.

Laparoscopic bilateral inguinal hernia repair, laparoscopic umbilical [EDIT: or rather, para-umbilical] hernia repair, zzz...


I managed to eventually escape so I could waste my time travelling to Centrelink for an appointment just so I could tell them things I could have told them on the phone...

Blah.

Squash in the afternoon was fun, as was a little bit of gym work.

I had decided yesterday that for dinner tonight (and for lunch tomorrow and probably the next day...) I would make pasta. I had purchased pasta sauce (because I cheat like that) on special (2 jars for $3!) and some fettuccine on special (500g for $1!).

Recipe as follows:

Ingredients:
500g beef mince

500g jar of pasta sauce (any flavour)
3 tomatoes
2 carrots
2 onions
1 head of brocolli
4 little chillis
as many mushrooms as you can find in your fridge (in my case, 4)
salt
pepper
tomato sauce
bbq sauce
500g fettuccine

Directions:
1. Brown beef mince. During this time, dice tomatoes, carrots, onions, brocolli, chilli and mushrooms.
2. Add tomatoes, carrots, onions, brocolli, chilli and pasta sauce. You may need to transfer to a pot as I did.
3. Add 250mL of water (half fill the pasta sauce jar and shake) and the mushrooms. Allow to simmer.
4. Boil water, adding some salt. Add fettuccine.
5. Taste your pasta sauce, add salt and pepper to taste. At this stage, the sauce should taste good, but quite mild. I like my sauce with a bit of zing so I added some tomato sauce, bbq sauce and lots and lots of pepper.
6. Check your fettuccine, I like mine slightly more on the solid side, but cooked.
7. Drain your pasta and serve in a bowl with a generous serving of sauce, with grated cheese.

I omitted some details in my preparation such as dancing around my house meeting and ending up with a ridiculous amount of pasta and sauce. I think I have enough for the next 3 lunches.

Of course, I"m not complaining. It"s good.

Great Exceptations

I typed the title of this post last night intending to blog about stuff, instead I ended up changing it and leaving the below post. Now I forget why I wanted to use this title.

On new housemates:
My unit is now a bustling suburban bedroom mini-community. From the first year aquaculture/marine biology students to the first year health science student to the German exchange psychology student, we"ve got it all! A friendly bunch indeed, mostly away from home for their first time, getting used to not having the roving parental eye of control over them.

On a failure of a Monday:
For the second time this rotation, a certain consultant has been away and unable to give us our eagerly awaited lecture. This is getting to be quite annoying, as they get their lecture times in advance by quite a few weeks, certainly enough to tell someone if a conference happens to be on that week...

On free food:
Ahh, O-week. With the new students coming in, the great annual welcome begins, with BBQ lunches, dinners, morning teas, afternoon teas, ice cream... All free! All it requires is a few omitted truths or small lies, and you"re free to munch away! Alternatively, you can do what I do and make use of the most important piece of information I learned on the wards: Look confident. As long as I look as if I should definitely be doing this and that it would be pure stupidity on anyone else"s part if they were to interrupt and question me about this, I can do (or eat!) just about anything.

On the gym and associated activities:
The annual free week from the gym, a time to stock up on exercise and activity to make up for the lack of these over the remainder of the year... I don"t know where I was going with this topic. All I really needed to say was that I"ve been going to the gym for the last week and now I will stop due to outrageous membership prices. Outrageous.

On surgeries and complications:
So being on the Surgery rotation, it would be expected that I should be going into theatre and seeing some interesting surgeries. Yesterday was one of those days with a laparascopic anterior resection. The initial preparation of detaching peritoneum (sigmoid mesocolon?) from the colon went smoothly enough, until the surgeon started exploring higher and managed to nick the splenic artery. This obviously wasn"t quite too big a problem as the surgeon deadpanned "Oh. No no no, don"t do that." and proceeded to clamp off the artery and asked for sutures, prodding on the nurse with an equally unexcited "Sutures, sutures, we have a bleeder." As I then expected the surgeon to cut open the abdomen due to the complication (which we were trying to avoid due to the patient being quite old and having an open surgery would make recovery a lot longer), I was very impressed with what happened next. The surgeon proceeded to suture laparascopically, which looked very difficult (much like trying to have dinner using 50cm cutlery) but it was done and the surgery was continued with no further complications. The patient looked well and in good spirits this morning. Wow.

On the musculoskeletal workshop:
Now, I don"t expect this to reach anyone that this will matter to, as I don"t believe I know of anyone placed locally in the course that actually reads this blog... I could be wrong of course, but judging by the lack of hits and the rare comments only by fellow bloggers in other areas, I"m probably quite accurate.
We had a musculoskeletal workshop yesterday, lead by a doctor who I believe gave us a spine examination session during GP week last year. It was brilliant. The notes given would have been worth their weight in gold (and a significant weight indeed) had they been given to us last year for when we were doing musculoskeletal clinical skills last year, but for now, they are just incredibly useful. These notes cover the various musculoskeletal and rheumatological examinations and include a DVD with clinical examinations. We"ve also been given an almost definite OSCE station, so that"s a good start too. For anyone who has yet to sign up or go and was considering skipping it, don"t, it"s well worth the four hours it takes (unless you"re a physio, then you know everything anyway...) and a lot of good practice too.

On expectations:
I"m not sure what I wanted to relate regarding this topic. It probably had something about the need to be in two places at once, but the consultant this week (the proper consultant, not the evil substitute one, mentioned previously... or not, that seemed to have been on a power trip as the main one was on holiday) was cordial, in fact I would say almost soft drink.

We had theatre this morning (a simple stoma reversal) followed by a tutorial on evaluation and causes of post-operative fever and presenting a surgical history. The consultant was very good actually, pushing for knowledge but not criticising the lack of it. I"m quite sure that I am seen as a moron as after a few seconds of silence and possibly a look of fear in my eyes, the consultant proceeded to answer the question given moments earlier. This consultant is also the first one to have given a set system for presenting a surgical history to a surgeon. In a nutshell (Oh help! I"m in a nutshell!): keep it simple. They don"t want to know all the "crap"* physicians care about, they just want to operate, "because honestly, its a lot of fun"*. So they just want "a history, not a bedtime story."*

All in all, an interesting week and it"s not even Friday yet!


Oh darn. SMS from Intern says Ward Rounds will start at 7:30am tomorrow. Not a good start.



* Indicates actual words/quotes from the consultant. Wonderful!

Note to self:

I have to blog about the following things:

• New housemates
• Monday fail
• Free food
• Gymming
• Laparascopic Anterior Resection + complications
  
• Musculoskeletal workshop
• Expectations

Maybe tomorrow...

Rotation 1 - Surgery - Day 1

Alright, so its 2 weeks past my first day of 3rd year, and I"m typing this on Wednesday, but Monday was such a productive day that I"ll have to talk about it.

While I"m at it, I"ll talk about today as well. Tuesday should be stricken from the history books though.

Monday, a beautiful morning, a smooth transition from waking up to ward rounds.
Always a good start, but it would get better. The ward rounds went smoothly, lots to learn but also lots learnt. Coffee break was a great change from our usual routine (no coffee), a nice treat from our Registrar, who has moved on to greener pastures (or maybe not... Modbury?).
I topped off the morning with a nice and easy bit of blood thievery, using for the first time a butterfly needle/vacuum tube. Left handed. Without a spoon.

Tuesday. Bleh.

Wednesday, today, a good morning which started with great anticipation, as the great handover would occur. Our new Registrar managed to find us, but our RMO was nowhere in sight. Luckily her pager was available. Sitting on the computer in front of us. Convenient, but understandable as they apparently have a full day orientation session. Probably high ropes and lots of clapping and laughing (yes, that is an inside joke, but you can laugh with me anyway whoever you are reading this).
So after about 30 minutes our Registrar left us, leaving the ward round to 2 interns, a GEMPIV and 3 GEMPIIIs. Big G* was eventually left behind, getting some paperwork done leaving Dr T* to lead the team. For amusement"s sake, I began to write "Colorectal Ward Rounds - Dr T* & Team" in the patient notes, half hoping that he would be called out, leaving us medical students to continue the ward rounds, perhaps flounder and drown. Moments later, Dr T"s pager pinged.
Unfortunately, we weren"t to be left to our own ward rounds. A patient on the wards had the Met team called, which gave us the chance to see what happens in a real Met call. Nowhere near the excitement of television, but interesting anyway.

To top off a fun morning, there were brownies in the intern room.

Ah, good times.






*Note: Names used are not their real names, but amusing replacements which the author has made up on the spot. They amuse me.