28th May 2007
I am so amazingly tired that I may even fall asleep before I finish this post! But I promised someone special that I'd write something new and I like to keep my word hehe.
Right, well I made it to the hospital this morning for 8am ward rounds...luckily. I was sort of asking for trouble by continuing to drive my car with the fuel light on but it didn't break down so I was happy. I can't remember if I explained about ward rounds, but basically the medical team (consultant, residents, registrar, interns, med students, nurses, physiotherapist) walk around and visit the patients under their care. We check how the patient is doing, make sure all the vital signs are stable (blood pressure, pulse rate, oxygen saturation) and that the patient is afebrile (not spiking a fever). It's also a time for making changes to drug regimens, ordering further investigatory tests and creating a management plan to ensure the patient dosn't spend longer than necessary in hospital (if you've ever stayed in a hospital, the desire to get out quickly, which is often brought on by the food, is pretty strong). Ward rounds can take up to 3hrs, depending on how many patients are under your teams care, so always eat breakfast and wear compfy shoes, because it is a lot of walking around, climbing stairs and standing.
Anyways, ward rounds went smoothly and we finished in 2hrs. We were sent off with the new intern to take some blood samples from a lady with a central-venous-line. A central line is basically a tube that enters the right side of the neck (can go into the left side, but you risk damaging something called the thoracic duct) and goes into either the subclavian or the internal jugular vein. It acts like a blood tap when you need to take blood quickly from a patient. You just insert a syringe without a needle and draw the blood back into the syringe. The blood can then be put into vials and sent to the pathology department for investigations. I felt so sorry for the poor intern who was showing us how to do this procedure. She kept saying how important it was to make sure the lids were on the vials really tight otherwise they have a tendency to come off and spill blood everywhere. Well...one of her lids wasn't on tight enough and we ended up having to mop a decent blood trail from the patient's bed to the mailing room (room where specimens/other stuff you want to send in the hospital is sent via little cylinders that travel in a chute to different levels of the hospital - pretty cool to watch).
Just as we finished sending the bloods off, one of the nurses came to get us because one of the patients was having difficulty breathing and complaining of chest pain. Luckily when we got there one of the senior registrars was already dealing with the situation. I was amazed at just how calm the registrar was, despite the fact that the patient was screaming. As there was a chance that the patient had possibly thrown a blood clot resulting in a pulmonary embolism (the patient was bed-bound which increases the likelihood of blood clots forming in the legs - these clots can then break apart, becoming emboli, which then travel through the blood vessels until they lodge in a smaller vessel, such as the ones in the pulmonary[lungs] system), or she was having a myocardial infarction (heart-attack), the registrar decided to give the patient oxygen and call the MET team.
A MET (Medical Emergency Team) is made up of senior doctors from ICU (intensive care unit), general medicine, anaesthesiology, respiratory, cardiac and vascular medicine. They respond to medical emergencies (Duh!) and are there to help and offer more bodies (sometimes more capable bodies - especially when you're the only intern covering the wards and someone arrests) to assist with everything that goes into saving someones life (if it becomes necessary). I mean, it doesn't matter how good a doctor you are, it gets pretty hard to ventilate, perform chest compressions, administer drugs, get the crash cart etc. and work out what's going on, all on your own. So yeah, the room filled up pretty damn quickly! Luckily the patient survived, and we later found out that she'd had a minor infarct.
Spilling blood everywhere and a MET call all in the first few hours of the day - a nice 'welcome to vascular surgery' for the new intern!
After the excitement, us med students snuck off down stairs to the common room for 'free muffin day'. We were met by our old intern (after several attempts at trying to remember the code to the door lock), at which point we knew that all the tops off of the chocolate muffins were now gone, but it was good to catch up. My friend and I shared an apple muffin - although now I know to stock up on food when you get the chance because it was the last thing I had time to eat until I got home at 6:30pm (my stomach was desperately trying to digest itself). I then went back up to the wards to speak to one of the patients I was writing a case-study on.
The afternoon was interesting but tiresome. I ended up going into theatre to watch an endo-luminal graft (ELG) being inserted. An ELG, when fixed in place, looks like a pair of paper pants with hooks at the waist band that attach themselves to the inside lining of the abdominal aorta. It is acts as an artificial artery wall when the original wall has become damaged and in danger of rupturing (mostly in the case of an aneurysm - dilatation [ballooning] inside the structure of the artery wall which weakens the wall). The patient we were inserting one in today had 3 anuerysms - one each in his left and right common iliac arteries and one in his abdominal aorta below where the renal arteries branch off to go to the kidneys. To picture this simply, look at your tummy. This isn't completely accurate but, imagine a cross (+) just above your bellybutton - the vertical part of the cross is your abdominal aorta, whilst the horizontal part represents your left and right renal arteries that supply the kidneys (of which you have two). Continue the bottom of the cross down past your bellybutton and imagine it forming into an upside down 'Y'. The branching bits angle each towards one leg and are known as your common iliac arteries. These in turn branch again (upside down 'Y') to form the internal and external iliac arteries in each leg. Finally the last branch to know for this operation is the superficial femoral artery which comes off the external iliac artery. If you press down into the middle of your groin area, you should be able to feel this artery pulsing (femoral pulse).
To insert the graft, cuts are made in the groin area on the right and left side and the femoral artery in each leg located (the operation is done under a general anaesthetic so the patient is asleep the whole time). The artery is then opened up (and blood pisses out everywhere until effective compression is possible) and a wire (catheter) is inserted into the femoral artery and threaded back up until it reaches the abdominal aorta. A lot of tricky manouvering is done to position the wires and get the inside of the arteries (the lumen) ready for the graft. The graft is rolled up in another fine tube like instrument - the right leg pant + top and 1/3 of left leg pant in one tube and the other 2/3 of the left leg pant is in another. The right section is inserted into the right femoral artery and threaded up to a place that has been marked, below the branching of the renal arteries. It is then 'deployed' and the 'hooks' at the top of the pants attach themselves to the inside of the artery wall. The left part of the graft is inserted into the left femoral artery and into the missing 1/3 of the pant leg. It too is deployed creating a set of 'pants' or a new upside down 'Y' shaped artificial artery wall, helping to restore blood flow to the lower legs and decrease the chance of the patient requiring emergency surgery due to a ruptured anuerysm. The wires and tubes are then removed, the femoral arteries repaired and the incisions closed. Of course this whole thing is a lot more complicated than that, but hopefully you get the idea.
The operation lasted 3 hours. 3 hours of standing up on a stomach fuelled by half an apple muffin (breakfast was used up on ward rounds lol). To make matters worse, it's really important that the surgeons can 'see' where the wires and graft are being placed. For example, if they go too high and block off the renal arteries than the kidneys won't recieve a blood supply and will become ischaemic (oxygen starved) and die - which is not a good thing because your kidneys are extremely important. So therefore there is an x-ray machine constantly in use taking 'pictures' of what's going on. Now because someday we might need our ovaries/testicles and cancer is a bitch, we have to protect ourselves from the radiation being produced by the machine. Insert lead gowns that go from shoulders to mid-calf, plus a lead neck tie to protect the thyroid glands in your neck. All I can say is heavy....VERY heavy. And standing up in these for 3hours is not much fun at all. Walking up 4 flights of stairs carrying them to see the display model of the graft is also not much fun. So yeah, I'm kinda weary and my shoulders hurt. But the surgery was interesting and I learnt a lot which is the whole point (at least it wasn't a ruptured abdominal aortic aneurysm cause those surgeries can last up to 9hrs!)
Bed would be nice, and a decent massage haha!
Just Sleep xx
