Assisting in a Surgery

As my twitter followers know, today I assisted in a surgery. I thought I would elaborate a bit more about that on here, share my experience and thoughts on the subject.
I now do my summer practicals at the surgical ward of the hospital, having done already 3 weeks at the nephrology ward. Yesterday I got to witness a couple of quite invasive surgeries, and I was asked if I wanted to assist in one today. To be honest, at first I was a little unsure, I mean, I had no idea what to do. I predicted that my assist competence would be about as good as that of Stewart Downing, in other words, not very competent at all. However, the junior surgeon who was explaining the procedure to me said I needed not to worry since I was doing it with the Chief of Surgery. I should just study up a bit on the surgery once I got home. Yeah, no pressure there.
We were performing an aortic bifemoral bypass surgery on an elderly patient who needed the surgery due to occluded arteries. In other words, the blood in the vessels had the fluidity of the traffic in Nairobi, and an alternative road was needed to avoid getting stuck. We were quite a team in the operation theater. There was the Chief of Surgery, another experienced surgeon and also a junior surgeon. Then there was an anesthesiologist, and a couple of scrub nurses as well.
Before we got started we "scrubbed in" as it is called. We washed our hands and arms in the surgical way, which takes as long as 5 minutes, and then we stood there T-rexing our arms in that boss surgical way waiting for our surgical gowns. When I had my gown on, and had put my squeaky clean hands in a pair of sterile surgical gloves we were ready to go. The chief and I on one side of the patient, and the other two surgeons on the opposite side. I'll now try to explain what the surgery was like, but if you don't feel like reading a bunch of medical terms, I'll include a short video at the bottom of the post of a surgery of the same type.

Firstly, an incision was made on each thigh, and the femoral artery was exposed at the location of the bifurcation of the profunda femoris artery. I held open the incision as the chief initially cut deeper to locate the artery. Then all the small blood vessels around the incisions were tied to prevent bleeding. Here I got to clamp the vessels, as the chief tied a suture around them. When the arteries had been exposed and the bleeding had been controlled, it was time for the big kahuna.
A long incision was made along the mid line of the patients abdomen. When the incision was deep enough to penetrate the peritoneum, I and the junior surgeon stretched open the abdomen using a pair of retractors. The chief examined the intestines to see that everything was ok, and enjoyed quizzing me on various anatomical structures in situ. That's right, not even I could escape having an oral quiz.
After confirming that everything was in order, the chief partly pulled out the intestines and put them on the patients belly in order to get to the aorta. Another incision was performed, now on the posterior side of the peritoneum, close to where the duodenum pierces it. And there, in all its glory, was the aorta. The aorta was cut open at the level which the inferior mesenteric artery branches off, and, obviously, there was a lot of blood splashing about. The chief commenced to pull out loads of old clots inside the aorta, part of which was causing the patient their problems. The aorta was then clamped, and the graft was prepared. The long part of the Y-shaped graft was implanted on the aorta, and using other tools, the two other short parts of the graft were pulled from the place where the incision had been made for the femoral arteries. It was quite intense throughout, as the surgeons were elbow deep in the patient pulling the graft along the original arterial course. The two short ends of the graft where then implanted on each of the femoral arteries. Thus, the bypass had been performed.
It was quite a gory procedure, with intestines and blood everywhere. The aorta was unclamped from time to time to test the sutures holding the graft in place, and whenever there was a small leakage the blood spewed out on everybody. The aorta was then clamped again, the leakages were fixed, and the aorta was again unclamped. This was continued until there was no leakage and the graft was firmly attached to the arteries.The main part of the surgery was now done, the two experienced surgeons left for lunch, and I helped the junior surgeon stitch the patient back up along all incisions, and bandage accordingly.
The surgery took 3 hours, and it was really tiring having to stand for all that time in a small space around the patient. However, for what I got to see and do, it was totally worth it. Even though what I did were things that could have been performed by anyone, I still felt very much part of the medical team. Tomorrow is my last day of summer clerkship, so to have got the opportunity to do this was really something fantastic. Hopefully this will be the first of many major surgeries I can assist in.

Off to the Butchery

I have now spent 3 weeks at the Nephrology ward at the provincial hospital of Olsztyn, doing my summer practice. It has been very interesting, and I have learnt many things, and have gotten to see a lot.
The first year summer practicals whole focus is on the job of a nurse. Even though I am studying to be a doctor, it is important to learn the basics of nursing as well. At the hospital, the nurses thought me how to give injections, including insulin and heparin. I also got to learn how to prepare various IV's that are given to the patients, and of course administer them as well. Maybe most interestingly, I have been able to learn how to draw blood. It was a bit intimidating at first, having to stick someone with a needle is never fun (well, in most cases anyway) and if the patients are scared that only makes it worse. However, after a couple of tries I got the hang of it, and I have been drawing lots of blood samples since. Aside from this, I have also got to observe loads of procedures, and have been taught the basics of patient care. All in all, a good three weeks.
Now, for my final week of summer practicals, I will be at the Surgery ward. I am really looking forward to it, and expecting to see some interesting surgeries. Surgeons do have a reputation of being a bit emotionally void, but I don't think that will be a problem. In fact, as I was out on one of my driving lessons, and I was conversing with the instructor about this topic, he highlighted this fact. He said that many surgeons after grueling surgeries usually resort to vodka as a means to manage the feelings. Sounds both primitive and absolutely intense. I will report back if the butchers, as the driving instructor liked to call the surgeons, seem a bit hung over on Monday.

The cart with all the nurse's equipment. My steady companion.

Nosebleeds and Electrocution

Nosebleeds... for the 20 years of life that I have enjoyed, they have been my steady companion. Unlike most people, who actually need to be hit on the nose to get a nosebleed, all I have to do is think hard enough and the floodgates open. It can be dry weather, just waking up, stress, overexertion etc. my nose will tell me I need to chill by opening the tap and starting to release my blood. The severity varies each time, as do the instances. One month I might be totally free, another month I'll have numerous nosebleeds. It has become a part of my life though, I see it more as a minor nuisance than something severe.
This past week I had one of those nosebleed frenzy weeks. In fact, when I came home from work yesterday, and cranked up Rattle by Bingo Players, I got a nosebleed from the sheer amount of bass that was pumping through my subwoofer. I love my sound system!
However, as I was lifting the latch of the wheels on one of the hospital beds, my nose started bleeding again. The doctor nearby told me it was not very healthy that I was getting so many nosebleeds from such trivial things, so she booked me an appointment with the ENT. (Ear-Nose-Throat Doctor, not Treebeard, even if that would have been way cooler.)
The ENT looked into my nose with one of those tools they use, and it took him about 1.57 seconds to confirm, "This is not good..." Apparently I have a congenital disorder which leads to dilated blood vessels in my Kiesselbach's plexus. Which in other words means that since birth, the small arteries in my nose have been exposed, and have had thinner walls due to their larger size. No wonder then that my nose is synonymous with the Niagara Falls.
Obviously, this problem had to be fixed. This is where it gets gory. First I was given an anesthetic spray up my nose, which was so sharp and stinging, very much like pepper actually, that any effort of keeping my tears back was utterly pointless. Anybody who has ever accidentally got piri-piri up the nose will know exactly what I am talking about. This was only the very beginning though. Then the doctor pulled out what can be best described as an electric rod, with which he was to cauterize (close, basically) my blood vessels with. I cannot even begin to describe the pain which followed, I swear that anesthesia had no effect, whatsoever. Each zap, nay, each freakin' Thunder of Mjölnir that rod delivered, was like a million siafu each clamping their  powerful jaws on the floor of my nasal septum. Time and time again. When it was finally done, the doctor begrudgingly told me that he wasn't able to get all the arteries in one go, I would have to return for more. I just gave a blank stare as an answer. The fun wasn't over yet! He propped up my now abused nostril with a bandage roll and told me to come back later. As if people weren't staring before, now I had a tampon up my nose to attract further viewers. Marvelous...

Seeking refuge in the Russian Toilet after the  Electrocution 

After two hours, when my bandage was so saturated with blood that it was starting to drip, I made my way up to the ENT ward for another dose of death. This time, either the anesthesia worked better, or my nerves had just had enough and were slowly abandoning me, because I didn't feel as much pain. That said, it was very far from pleasant, very, very far. About as far as the gap between Arsenal and Sp*rs #mindthegap. Anyway, I got it done, and the doctor felt he had got all my little bleeders. I go back tomorrow for a checkup. Oh, and I no longer have to wear that thing in my nose (hurray!).

 I might indeed miss my random nosebleeds, I think over time I have developed some sort of Stockholm syndrome for them. However, it will be nice not having to fear for my life each time I have to blow my nose. So is this the end of me and my life long nasal companion? 

Who Nose!! 

Peculiar Polish Patients

Working as a nurse's aid after my first year of medical school has brought me in contact with a lot of special people. Since I am doing my practicals at the Nephrology department, the patients are mostly elderly. One of the big barriers of communication with the elderly is of course the language. Unsurprisingly, English is rare, with only the very well educated (doctors, professors etc.) knowing any at all. English is usually found, if at all, among people under the age of 30. Middle aged and elderly individuals usually know some Russian, having been born during the Communist days. Interestingly, the eldest of the elderly, people around 80 years old, know German, since Olsztyn used to belong to Prussia. Then the city was called "Allenstein". However, with my limited Polish I can usually get by, but anyway, back to the peculiar patients.
 As I was accompanying a couple of patients and keeping check on them while they waited for their tomography, the secretary in the waiting room turned on some nice classical music.
-"Great", I thought to myself  "every old person loves some nice classical tunes!" So I nudged the old gentleman sitting beside me and asked him if the he liked the music. He replied with a half-raised eyebrow that it was indeed OK. Not really convinced of his answer, I questioned him further,
-"Don't you like Bach, Mozart, CHOPIN!!" (Chopin is to Poland's classical music as George Washington is to America's politics, eternally exalted and without any faults whatsoever.) Unimpressed, he told me he was more into modern music. Now it was my turn to raise the eyebrows.
-"Yes, you know," he began, "I really like that music with the nice base, like rap". My eyebrows were now almost one with my hairline. "I don't now any names, but I really like those artists. Oh, do you know where Ostroda is?" I nodded, saying that I had indeed heard of this little town outside Olsztyn. "Well, there is a big reggae festival there," he said with an undoubted smile. Remember, this man was like 60-70yrs old, and he was telling me where the best concerts where at. To say I was shocked would be an understatement.
A bit baffled by the surprising reggae fanatic of an old man to my right, I switched my conversation to an even older lady on my left. She was one of those people who also knew a bit of German, so we had a nice little Polish/German converstation, which is peculiar since I don't actually speak any German. I just "Germanified" my Swedish, and it seemed to work.
As I was getting ready to head back home, another old lady, a visitor at the ward, saw me with my phone. Observing that I indeed knew how to operate such a machine, she asked me to come quick and help. We entered the room were the patient she was visiting was lying, trying to figure out what to do with the phone. It was currently ringing, and they very excitedly asked me what one should do in such a situation. I, trying very hard not to seem condescending, pointed at the big green button and told her to press it. With her whole body strength she pressed the big green answering button, she could have broken it with the determination she had, and started talking very fast and happily with the person on the other end. Hero deed of the day? Well, yes, yes indeed!