The first cut is the deepest

I don't know who said it, but they were wrong. And also kinda right.

This week has been my first week on attached to a surgical firm at St Clabert's and it's been a reminder of what I know and what I don't.

The first point of call was that, until this week, I'd never been further than the anaesthetics room in theatres (other than as a patient). In ward life you know of theatre people and maybe have the occasional tussle in recovery, generally about how you're not taking the patient who is groaning in pain and who's BP is in their boots back to the ward. But I'd never before donned scrubs, clogs and a hat and walked into theatre. It is a strange, controlled, precise place compared to the ward. It was refreshing to experience this change of pace and bear witness to a kind of calm teamwork that I've not seen much of before now.

And the first cut. I realised, when I saw the scalpel go in, that I had never seen this happen before, either. Don't misunderstand, I've assisted in plenty of drain insertions, ascitic taps, biopsies, endoscopies et al, but never seen a person cleaned, draped and then surgically incised. It was amazing. I didn't expect it to be a notable experience, but it left me literally agape (and then when I realised, quickly stoical - I mean, no-one wants to look like a noob in theatre).

This week has quickly taken me out of my comfort zone as anatomy is one of my weaker points and being quizzed about specific muscles and their attachments and insertions and innervations and (god forbid) arterial supply or venous drainage is just awful for me. I've had to claim ignorance and face disapproval more this week than my ego is frankly comfortable with and had to accept I really need to spend more time with Netter if I want to get the most out of this placement.

The high points have (unsurprisingly) been history-taking, clerking, examinations and ward life (both pre-op and post-op). I fully expected this to be the case, given my previous life. I love being on a ward, talking to patients, sitting with them to take a history, busting out the stethoscope, percussing, palpating, the whole nine yards. Which I guess says something about my medical bent.

So far this has been a good placement and I have several weeks to go, so more time to get comfortable in theatre, maybe even scrub in and hold a retractor or two, more time to get my muscles and nerves straight in my head, more time to reinforce the ward skills I have brought with me.

Now if you'll excuse me I have an important meeting with the intrinsic muscles of the hand...

Malta

Malta, a set on Flickr.

Part 1

Jobs is dead

*iPhone rings*
Mrs AB:"Hey, did I wake you?"
Me: "Nah, just coming to."
"Steve Jobs is dead"
"What?"
"Steve Jobs is dead"
"What?!"
"He's dead"
"Jesus. Well, he did have pancreatic cancer, I guess."
"Yeah, but y'know, 56."
"Yeah. Wow."

The world has lost someone who did something amazing and had so much more to offer :(

Getting hands on

Mr. McGuire: I just want to say one word to you. Just one word. 

Benjamin: Yes, sir. 

Mr. McGuire: Are you listening? 

Benjamin: Yes, I am. 

Mr. McGuire: Plastics. 

Benjamin: Exactly how do you mean? 

So we've had six weeks of PBL tutorials, statistics and communications seminars and clinical skills sessions and now, like so many baby birds, we're being let lose from the nest lecture theatre to fend for ourselves. For a bit.

My first rotation is 6 weeks of plastic surgery, allegedly with a hand specialist. Which carries all manner of silent terrors for me as I find the anatomy of the hand and forearm crazy complicated. And being in a theatre gives me all kinds of opportunity to fail to observe some anachronistic aspect of human interaction and get bawled out for my troubles.

But the upside is I have a fair bit of post-surgical HDU nursing experience and know the general tone of surgical ward life. And in many ways my current form was birthed on the wards of an NHS hospital. I don't mean that in a creepy "buffalo bill" kind of way (well, maybe a little bit...), but who I am now is very much the product of having lived and worked in the healthcare environment for quite some time. I hope I can fit back into the pace of things like a hand in a glove. No pun intended.

And then there is the undeniable fact that surgeons are the people who reach into the very living flesh of another person and fix them. This is something incredible to be sure. I can understand where the idea that surgeons sometimes see themselves as gods might come from - If you can make someone better with your hands and bit of know-how, you could forgive yourself for being changed from the experience, too. I look forward to seeing the fixing happen first hand (again, no pun intended) and to find out how the life of surgeon actually works, when they're not writing up post-op fluids or taking down dressings at 9am (don't get me started...)

I don't know if I am a surgeon (though I have nursing friends who promise to disown me if I become one!) or a medic, and to be honest, I don't know if it's relevant for me to wonder this without more experiences to form an opinion. To pass the first year without resit or hinderance showed me I can do this, that I am med student (hear me roar!). What I make of my opportunities and experiences waits to be seen, I guess!

PS There will be Malta pictures, once Flickr stops being in a strop with me.

A break from your (ir)regular programming

Myself and Mrs Absentbabinski are on hols this week in Malta, so no posts of any consequence for a few more days. It is lovely and if you like swimming in the Mediterranean sea and 32 degree (celcius) days of unending sunshine, I can highly recommend it.

I dare say there will be a debrief post and a few pics when I get back. Assuming London hasn't been razed to the ground.

In the meantime, "Saha" as they say over here.

- Posted using BlogPress from my iPad

London Riots

Although the news has been full of them, the London riots have ended up being more rumour than riot for me. I have passed damaged shop fronts on the bus and I have seen footage on the TV of violence, arson and ineffectual policing, but so far I guess I have been lucky enough to not have them directly effect me.

Working at my hospital yesterday, the day was full of rumour, half-truths and supposition which I found myself getting drawn into more easily than I expected or wanted. They were boarding up the high street, then there was a riot on it already, then that was discounted. Then there was talk of other places being targeted. Nothing to support this other than something heard from someone else who had a friend who knew about it. It's weird how the contained group of nurses all fell to recirculating rumour in lieu of fresh information. Then the hospital quietly advised non-essential personnel to leave by 4pm and said they would be locking the main gates before night fall. I began to feel ever more uneasy. 

From the third floor of the hospital I could look out over South London all the way to Canary Wharf and it was amazing to me how there was no difference I could see. Life was just rumbling on, same as it ever did. When my shift ended I legged it out of the hospital and headed to the train station. Every group of people, no matter how innocent they looked, made my spidey-sense ping and it was all I could do not to sprint for the train. As I got to the station I was passed by two horse carrier lorries, blues and twos going and zooming off to an incident somewhere. On the platform I overheard a group of police officers on their way to work debating whether or not annual had been cancelled.

My wife had been working up in North London in a shop and had had the police come around and tell her to shut up shop and go home. In the middle of the afternoon. She had tried to do a bit of food shopping on the way home only to find all the supermarkets by us shut and some even boarded over with plywood in preparation for violence.

I am torn between worrying about the next few nights and thinking that this will blow over soon enough. The Met have made lots of noise about intensifying policing in the capital and their no-nonsense approach to public order offences is well known around the UK. They are issuing plastic bullets and allocating water cannon.

I'd also like to raise my voice to join the choir of Londoners appalled by the behaviour of a violent and antisocial minority. The best description I have come up with is an amalgam of disenfranchised people, who have been raised on a diet of mass consumerism, with nothing to lose and little fear from prosecution. Arguably a very dangerous combination. That there has been such a united front against these people is something which gives me hope for the city and the species in general.

Are you sure this is a valid prescription?

Seen yesterday on the PRN side of the drug chart:

Vodka 50mls PO

on the same chart, regular side:

Chlordiazepoxide 20mg QDS

The nurse who picked this up bleeped the pharmacist who briefly did a good impression of a beetroot and then looked like they were about to lay an egg.

The pharmacist's main issues were:

a) Why wasn't this patient (who was an alcoholic) being detoxed?
b) Where did the doctor think they had medicinal vodka in the hospital?
c) What was the doctor thinking prescribing alcohol *and* a benzodiazepine together?

Sadly, the pharmacist left before the doctor arrived to sort out the chart. My favourite part of this was the doctor's eye-rolling and suggestions that the pharmacist was being over the top in getting upset about this. Oh, and then asking around the ward if we knew what alcohol pharmacy *did* stock.

So many of the shifts I've worked over the summer have been guides on what not to do as a doctor. Behaviour-wise and common sensical.