chemicallvs

18th May 2007

I'm half way through my surgery rotation and it's been tough.  Partly due to the hours (14 hour shifts some days and we're not even getting paid) and partly because of how sick I've been.  That's one of the biggest problems with working in the hospital environment - if you haven't been looking after yourself and you get run-down, you'll get picked on by anything that can tackle your immune system to the ground (and my immune system wears glasses and is always being shoved in lockers).  But it's been interesting so far and I've had plenty of clinical exposure.

At the moment I'm attached to the vascular ward, so I see a lot of patients recovering from bypasses, aneurysm repair and amputations - a lot of amputations, many of them due to the progression of Diabetes. 

Diabetes Mellitus refers to a lack of/reduced effectiveness of insulin.  Insulin is a hormone secreted by the pancreas, which helps regulate the body's glucose levels (eg. storage of glucose in the liver).  Diabetes comes in two forms.  Type 1 diabetes (or insulin dependent DM) usually appears in childhood and results in a dependency on insulin injections because the insulin secreting  beta-cells in the pancreas have been destroyed.  Type 2 diabetes (non-insulin dependent DM), however, occurs due to a decrease in the secretion of insulin or the development of insulin resistance in the body.  This form is associated with obesity, lack of exercise and calorie excess - therefore, there are things you can do to prevent it or at least lessen your risk of developing it later in life!  And seeing the devastating effects of diabetes would definately scare me into trying to be healthy.  It often results (especially if poorly controlled) in micro- and macrovascular damage, which eventually may result in you needing an amputation.  Not fun.

I watched my first below knee amputation on Tuesday.  I think brutal is the only word to describe it.  You really appreciate the force needed to actually break a bone as you watch the surgeon struggling to snap the fibula in half.  The patient was only under a spinal block because he was allergic to the general anaesthetic.  He wanted to watch the procedure but the surgeon didn't think it was such a good idea, although it was pretty cool to watch (granted I am a medical student and used to seeing 'blood and guts').  They used this really awesome surgical cutting wire to 'saw' the tibia in half - it pretty much slid through the bone like it was butter.  I also got to feel the artery that was cut away.  Arteries usually feel a little like cooked spaghetti, but this one was so full of atherosclerotic crap it felt as if the spaghetti was half-cooked (hard in the middle,squishy on the outside).  It was pretty surreal watching the lower part of the man's leg being put into a biohazard bag...zombie movie images kept flashing through my brain lol!  The whole operation took about an hour.  It was pretty funny at the start because 'Welcome to the Black Parade' started playing on the radio and I just thought "yep, appropriate" considering the patient lieing on the table in front of me.

Oh and surgical scrubs are not sexy....I don't care how they look on Grey's Anatomy.  The hair nets and booties are pretty cool though... I might steal some to wear for fancy dress hehe

Other interesting events...umm... well we had a patient walk out of the hospital with one of our $30,000 vacuum dressing machines....been checking ebay for it...

On a sad note, one of our patients tried to commit suicide by strangling himself with the cord to his oxygen mask.  He was suffering so much from phantom limb pain (perceived pain in the limb even though it has been removed).  He's on constant monitoring now.

Another of the common cases we see on the vascular ward are patients recovering from surgery to repair abdominal aortic aneurysms (AAA).  An aneurysm is a dilatation (like a ballooning) of an artery (in this case the abdominal aorta) due to widening and expansion of the lumen. They are rare under the age of 60, most are asymptomatic (don't cause noticeable problems) and, if detected, are surgically treated when greater than 5.5cm (risk of rupture is fairly low under this size).  However, sometimes they aren't detected and can rupture (dissection) - which is a medical emergency!  50% of patients don't make it to hospital (100% mortality if you don't get medical assistance).  50% of those who do, die on the operating table.  50% of the patients who survive the operation will then die from further complications post-operatively.  In other words, if you survive and go home, you're pretty damn lucky (if you consider it to be luck).  One of the patients under our team's care had a nasty dissected AAA.  The operation took 9hrs to repair the aorta and the patient has subsequently suffered from many complications.  He ended up throwing blood clots into his peripheral vessels and devloped compartment syndrome in both his legs.  Compartment syndrome results in increased pressure in the limb - with the first sign of it being excruciating pain.  He required bilateral fasciotomy (cutting a layer called 'fascia' in the limb to relieve the pressure) medially and laterally in his legs.  His kidneys have been damaged due to the lack of blood flow to them when the aorta ruptured and when the surgeons clamped the aorta to stop the haemorrhage - he now has to have dialysis (a machine performs the function of the kidneys).  Now he's suffering gastrointestinal problems which we are still investigating.  The complications of a ruptured AAA are numerous and everyday I hope I'll still see him on ward rounds.

Our intern is fantastic - plus he introduced us to free muffin day.  Although he did find it hilarious sending us to put a cannula into a lady he knew full well had terrible veins and we'd never be able to get it in (oh haha - just you wait...).  I feel really awful about turning some of my patients into pin-cushions whilst trying to draw blood - but I guess you gotta start somewhere.

I had a good mid-semester review so that made me feel better.  I need to speak up more and become more confident though...something to work on.

Otherwise...dog is good...she's asleep right now.  I've written a few songs but I still need to get the music going for them.  The guitar is still awesome.  I'm pretty tired.

So Long and Goodnight xx