From Surgical Emergencies to Learning Disabilities

Hi,

For the last week of my surgery attachment I was on the Surgical Emergency Unit, where A&E and GP referrals with problems potentially requiring surgery come. The ward is a bit different to all the other surgery departments, and the attachment was more like being "on-take" with the medical teams because it involved a lot of clerking in new patients and plenty of practise putting lines in veins and taking blood. Rather than being at the hospital around the same times each day, the week was divided into shifts between the 7 medical students in my group. This meant that there were never more than a couple of us on the ward at once so we got to do more and weren't fighting for patients to see. It also meant that we got to experience more of the hospital at night, since the shifts covered all hours. I really enjoyed my night shifts, especially when the unit was busy and I could really be useful helping tired doctors (some of whom had been on for 48 hours without a break!). Most surgical emergencies involve abdominal pain (either right lower quadrant, usually appendicitis; right upper quadrant, usually cholecystitis; or left lower quadrant, usually diverticulitis) or rectal bleeding. However, there were some exciting variations, including a lady with no blood flow to her arm and a man with a very low calcium level after having a vital parathyroid gland accidentally removed along with hos thyroid in an operation I saw whilst I was on the breast and endocrine surgery attachment.

Exciting though SEU was, it was also extremely exhausting. My shift pattern managed to combine with tutorials scheduled inbetween to give a few rather sleepless days. A week of disrupted nights was survivable but I was glad to get back to a normal sleep pattern. I've been off on a curch weekend away this weekend so haven't caught up on a lot of sleep but I've got my Special Study Module next, which seems to involve later starts than the 7.30 and 8am's I've had for the last 6 weeks on surgery (I don't have to be in until 9.30 tomorrow!). We choose whatever we want to study for these special modules, and I'm doing Learning Disabilities with the psychiatrists. I don't really know what it involves yet (apart from including an essay, presentation and poster as part of tthe assessment) but it sounds like fun from speaking to people who've done it before. I'll let you know how I get on soon!

Bye.

breast and endocrine surgery

Hello,

I've just finished a week of Breast and Endocrine Surgery, which was a bit quieter than Plastics, but still very interesting. I went to see a few breast lumps being removed (one mystery lump that apparently looked like a hamartoma, which is a benign growth that can occur anywhere but isn't a normal cause of a breast mass; and one phylloides tumour, which is apparently not very common but seems to be the main diagnosis of all the breast patients this week!), and I also went to see some endocrine surgery and helped with the removal of half a thyroid gland. I was able to help a bit with cauterising blood vessels, which I hadn't done before, as well as the usual retractor-holding, and I got a good feel of the anatomy in the neck from the skin right down to the vertebrae.

The breast clinics involve "triple assessment" of the patients. This means that they are examined by a breast surgeon, then move on to a pathologist for a fine needle biopsy of any lumps, and then supposedly see a radiographer for a mammogram (or ultrasound). Unfortunately there weren't any radiographers around this week so I didn't see any mammograms, but I did see a core biopsy (where a little column of tissue is taken out by a special needle) as well as the fine needle aspirations, and the surgeon I was with let me feel all the lumps and bumps. It was also interesting to see how differently patients reacted to very similar circumstances, and the parts of their diagnoses or treatment that concerned them most.
The endocrine clinic was less practical but more varied, with patients presenting with anything from repeated kidney stones, possibly due to abnormal calcium levels from a parathyroid gland tumour, to very obvious neck lumps. The endocrine surgeons are also general surgeons and do things like hernia operations and gall bladder removals too.

Today, like all Fridays, started with an early morning "Grand Round" lecture (by the colorectal surgeons, on rectal prolapse). Normally, Fridays also end with lectures, as part of the year 4 course, but today we had a test instead just to help us see how we're progressing. And this evening I have a double tutorial with my surgical tutor to look forward to! Until then, I'm off to the library!

Bye!

Plastic surgery

Hello,

I'm half way through 2 weeks with the plastic surgery department now. Compared to colorectal surgery, the attachment has been astonishingly organised. We were welcomed and given a personalised tinetable when we arrived, although we don't have to stick to it if we don't want to. The surgeons are all happy to teach and even the consultants have been far more willing to talk to students than any others I've met so far.

Last week I started off on the wards, taking histories from patients to get an idea of the variety of surgery that takes place in plastics and helping the house officer with jobs like cannulating veins. Then I went along to minor ops and saw various lumps and bumps being removed and the holes grafted over (and in one case, an ear being reconstructed). And I've also spent a few days in the operating theatres watching and where possible assisting with surgery.

I was able to get some hands-on experience of a mastectomy and breast reconstruction case, which involved some amazing microsurgery to reconnect the blood vessels of a flap of skin taken from the abdomen to the chest wall (unfortunately it also involved me holding a retractor very still at a very awkward angle for a very long time with a surgeon leaning on my arm very hard!). Despite the ocassional discomfort, helping practically with surgery allows you to get much closer and get more of an idea of the intricacies of the surgery than just standing back and watching. Getting involved hasn't always added to my view of the operation though - during one case last week a vital peice of equipment for making a feeding hole into the stomach of a child went missing and I was instructed to run to the other end of the hospital (looking rather silly in my surgical scrubs!) to get another one, but when I got back the original piece had already been found and I'd missed seeing what it was used for!

One of the most extrordinary operations I've watched was a reconstruction of a congenitally deformed hand, requiring the hand to be almost completely separated from the arm before being repositioned and pinned in place. Other, slightly less dramatic, operations have included the removal of extra toes and the bending of broken fingers back into place. And next week I'm hoping to see some head and neck cases too.

Plastic surgery is certainly one of the most varied specialities I've seen so far. The department has a lot of paediatric as well as adult patients, and just wandering around the wards you see everything from thumbs made from toes, to babies with most of their brains outside their skulls in encephaloceles, and people lacking in large portions of their faces following gunshot wounds. It has also provided me with an interesting breast reconstruction case to write a report on, as part of my assessment for the surgery attachment.

In fact, I should get on with writing that now...

Bye!