Thursday, July 31, 2008

Brain surgery

Earlier this week I had to chance to scrub in and assist* on brain surgery. Very, very cool.

This article describes the way it's done at the hospital where I'm based. I assisted the neurosurgeon featured in the article - he's a great teacher and very nice.

This MRI-guided surgery is interesting, but it takes a long time. It took over an hour for the patient to be prepped and anaesthetised. Then the initial scans and planning took over an hour. After all that waiting, it was a relief to finally scrub and get started. I ended up leaving after 5.5 hours, when the operation halted for more scanning. The scan showed a lot of tumour still to be removed, so the operation would have continued for several more hours.

More on neuro at the end of the rotation. I need to get back to preparing for the long case, which is in 2 weeks. Eeek!

* There's not much a medical student can offer when it comes to assisting on brain surgery! I was in charge of irrigation during drilling, and suction. I was pleased to discover that watching the surgeon drill through the surprisingly thick skull didn't bother me at all.

Monday, July 21, 2008

Too many broken hearts

I typed "heart" into the Search field in my iTunes and lo! What a collection of wonderful/scary/strange songs appeared. It was hard to select just one to use for the title of this post, but in the end, how could I go past Jason Donovan?

(Why do I have a Jason Donovan song in my collection? It's part of a compilation of other [better] music, though I must confess I do love this song...)

Well that was a lightbeat start to a post that's anything but lightbeat.

Last week I finished my 6th rotation for the year - Cardiology. As you can see in my last post, I was excited about this rotation and generally a happy little camper about everything. One month later - not so much.

Cardiology is a very busy department - at my hospital, there are 3 teams of registrar/resident combinations, with 5 or 6 consultants attached to each team. The team I was on had anything from 15-25 patients to see each day, which meant that ward rounds took a very long time. On my first day, the registrar basically told me not to expect much teaching from him, because he simply has no time.

That was OK - I expected it. It was clear that this rotation would require me to be proactive if I wanted to get anything out of it. So it's a shame that this rotation coincided with my development of Killer Fatigue (a phenomenon often seen on The Amazing Race).

It's been a long year, with only 1 week off during 8 months. And I reached a point in the second week of my Cardiology rotation where I just couldn't get out of bed. I ended up taking 2 days off in week 2, and I slept, got some uni work done, and tried to summon up some motivation.

In week 3, I had to deliver 3 separate presentations at uni. They all went very well, but I was absent from the ward a lot, finishing them off.

All of this added up to not much time for me in the Cardiology department. I tended to be there for ward rounds in the morning, have lunch, then either do a long case or go home (the latter more than the former).

Of course it didn't really matter in the end - the registrar signed my form at the end of the rotation and wrote in the comments, "Good attendance". What a joke.

So I didn't really love this rotation, but it's not Cardiology's fault - I blame the Faculty for their poor planning. For the third years next year it looks like there's a week of holidays after the first 16 weeks, and then a week off after each subsequent 8-week block, which is much more sensible (but still not ideal).

Anyhoo, let's do this again, just for consistency...

  • Best moment: A patient had a planned cardioversion for atrial fibrillation. This means I saw the patient receive an electric shock to her heart. It was the first time I've seen this in real life. Being a planned procedure, the patient was anaesthetised, and shouldn't have felt much/any pain. It was interesting to see how the patient's body responded to receiving the shock - she jumped, and raised her arm so that it looked like she was warding off an attacker.
  • Weirdest moment: I did a long case on a male patient, and he gave me a "true blue" recipe for scones! Apparently the secret is flat lemonade...
  • Worst moment: A male patient had just been flown in from the country after having a heart attack. It was late afternoon, so he was being rushed into the cath lab for angiography +/- stent. It was busy - doctors and nurses everywhere, people talking over people - chaos. While this was happening, the registrar from the cath lab had a brief chat to the patient to explain the procedure and get consent. One of the questions the registrar asked was "Do you smoke?" - a standard (and very important) question, which the patient answered in the affirmative. So the registrar thought this was the perfect time to lecture the patient (very loudly, having to yell over the noise everyone else was making) about the fact that if he wasn't a smoker, he wouldn't have had a heart attack and wouldn't be in the hospital today. Ooooh it made my blood boil! Did she seriously think that was going to have an impact at that moment? It just made her sound like a pompous holier-than-thou asshole. (I felt sorry for this patient during the procedure too - his IV tube got caught on the X-ray machine and ripped the cannula out of his arm - not a pleasant experience.)
So it was really bad timing for Killer Fatigue to hit this month. I've got the long case coming up in less than a month, and I need to be doing (and presenting) several long cases each week.

And it's hit me in the non-uni parts of my life too. For example, I'm very unmotivated to exercise - and far too motivated to eat bad food - so I've put on some weight. Not unusual for winter of course, but I need to do something about it.

Oh - and just to keep you completely updated on my life: the guy I was dating (who I met online) seems to have disappeared without explanation. If he's the type of guy who thinks "incommunicado" is appropriate, then I'm well shot of him. But definitely not a happy camper.

Despite all of the above, I'm feeling a lot better this week, and hopefully I'll be more motivated for my next rotation - Neurology and Neurosurgery, which started today. A good rotation to be on in the lead-up to the long case. This week: finish my ethics essay (hopefully today), do lots of long cases, go to the gym at least 4 times, go for a run, cook good food, and stop eating bad food.

And I think my love life (such as it is) needs to be placed on hold until third year finishes in September.

9.5 weeks till the end of third year!