I always thought i wouldn't like surgery, i have this perception of surgeons as a 'fleeting' doctor in patients lives, not getting to know the patient or becoming very involved in their process of healing and health at all. Someone has the air of 'god' and knows it and as such is not liked by other doctors. I perceived surgeons as more heartless than others, just wanting to 'chop' patients and not considering other options as though the other doctors have done that and hence the last option is to operate. But this past week has proven me wrong, but i guess that is an exciting part about hospital experience :)
Surgeons are very much still human, they like to get to know their patients, they can be more kind and caring than doctors of other specialities that i know and they certainly do not simply 'chop' without looking at other options first, that is why patients have come to them for a surgical REVIEW not an necessarily an operation right away. There is so much involved with pre-operation checks and assessments in every system of the body to prepare the patient for surgery and correct systemic conditions as best as possible to allow the patient to get through a surgical procedure or become well enough to enable no surgery to take place and therefore not exposing the patients to the risks associated with the surgery. Patients trust surgeons with their life, more than they can trust other doctors, after all you are basically saying to a surgeon 'knock me out and take control' which in many surgeries involves letting medications and machinery control your breathing, heart rate and blood pressure... the vitals which enable you to live. And surgeons are extremely good at it i can see why they can be regarded as 'part god'.
The team i am attached to for the first 4 weeks is a vascular team.Already i have learnt lots about lower limb vascular diseases and examinations and diseases of the vessels. On my first day, Monday, we met the doctors who are thankfully extremely nice and very open to teaching us!! (we are lucky compared to other teams where their doctors barely make eye contact with the students) Myself and another student who had done his scrub session too followed our consultant to a surgery and watched a carotid endartectomy where a major blood vessel to the brain was occluded 80-90% on the right so very little blood flow was getting through. What is amazing is how the surgeons were able to open the vessel, cut out the blockage and suture it back up with minimal blood loss!! They clamped the vessel initially as the other 3 vessels can usually supply enough blood to the head for the duration of the surgery but not in this patient her pressure was too low even when they pumped up her systemic pressure to 200 systolic. So they had to unclamped and very quickly make cuts in the vessel to put in a stent around what was to be repaired/unblocked. With blood under high pressure coming off the heart there were a few squirts of blood which surprised me as they shot across the room (i found out why they were wearing eye gear then :P).
Of course this added extra difficulty when taking out the stent and suturing the vessel back up again and in the pressuring times where there was the risk of major bleeds or failed closure i admired the surgeons ability to stay so calm, yes he had done many surgeries before but i liked how he would hum this one tune over which he worked quickly and efficiently in the more pressuring parts, so cool, calm and collected. I was able to talk to the patient the next day and see how she was going. I found it amazing to think i had seen the textbook anatomy in her neck and seen what had been done and knowing how this will improve her life.
On Wednesday i was able to go to the Cath lab and watch an operation through glass which was apparently the 2nd one to be done in the world!! It was a patient who had a dissecting aortic arch from the heart and they had to put in a stent. To do this they went in through the femoral artery (in the groin) and one from her brachial artery (in her arm) and met at her heart feeding the wires into place and making sure they didn't put the stent over blood vessel openings particularly over the carotids to her head!! To get the stent in place they had to 'stop' her heart. To do this they would put her heart rate up to 250-300 beats per minute so her heart was not contracting properly but sort of 'vibrating' on the spot to stop the blood flow and turbulence. This was only for 10second periods at most then her normal heart beat and blood flow was restored. It was amazing to watch, they had 'TVs' up with the imaging of the heart/chest so we could see where the stent and wires were for their placement and they would inject dye to check the blood flow and to see the vessels better for any occlusions.
 |
An example of an angiogram of the aortic
arch and a visualizing a stent
(NOTE these images are
from the internet) |
I was fortunate enough to have a great chat to a lady next to me who i found out was a training surgeon on maternity leave, she was so enthusiastic about giving us information and talking through the procedure it was great! She also started talking about her decision to have time off her training to have a family, many people told her it meant she did not want to be a surgeon and she didn't have the dedication (mainly men who do not have to worry about the impact of having a child!) which is just silly!! Just because she wanted to be a surgeon did not mean she had to sacrifice having a family. She has the rest of her life to be a surgeon and cannot have children forever. She also said she does not want to be a working mum who does not spend time with her children and is able to balance her medical career with being a mother. The rest of her surgery training will come later but for now she is caring for her children but still assisting on the odd surgeries and learning from watching others such as this one, a good way to go :) I told myself 'See? even a surgeon can balance a good family life!!' after all, we are women, we stick to our missions and we are very good at multi-tasking ;)
A fun fact i learnt from her which i feel i should have already known... when they do kidney transplants they leave the dying kidney inside the patient!! The body just deals with it naturally and all it does is shrink without doing any harm! I learn something new everyday :P
So 1 week down and 7 weeks to go and my initial ideas of this surgery rotation have been squished. I have really enjoyed my first week, i am lucky to be in a great team of both doctors and medical students, i find the surgeries and medicine so interesting and exciting and can't wait to see more next week and i love wearing scrubs! ;) Although i wonder whether i would have the confidence to be a surgeon, (and whether every theatre would have a stool for me to stand on) maybe there is more surgeon in me than i originally thought?
No comments:
Post a Comment