chemicallvs

8th June 2007

I've managed to completely screw up my body clock - I don't think it knows what time it is, what day it is, and it keeps wanting to party like it's 1999.  You know who I blame?  My stupid surgery work-book, which was due this week, that's who!  Oh and myself, because I compete at a world level in procrastination.  I'm really not too sure how much sleep I've had this week but I know right now that I've only had 3hrs in the last 2 days and, surprisingly, I don't feel too bad.  Just don't jump in front of my car....I may not react till next week.

Every time I start a new rotation I promise myself that I'll start assignments early and keep up to date with lectures so that I don't end up in a major panic in the last week of term.  But it never happens - especially when I've missed half my rotation due to being sick.  So yay for WMHL keeping me awake in the wee hours of the morning that my work-book was due so I could finally get it finished.

So what have I learnt in the last week or so of surgery?

Well today I watched a septoplasty being performed.  Basically it's a procedure used to reconstruct/re-build the nasal septum (that bit that divides your nose into two holes).  The patient had damaged hers during a motorcycle accident, which resulted in her left nostril becoming entirely occluded (blocked).  I also spent the morning at the local children's hospital in the Ear, Nose and Throat (ENT) clinic, coming to the realisation that tonsillectomy (removal of the tonsils) isn't such an easy and relatively safe procedure as I'd once thought. 

My tonsils have been giving me hell my entire life and I'm always pushing my Doctor to let me get them taken out (thinking that the operation is so common and not much of a big deal).  But now I know otherwise.  This poor little 6 year old boy had his tonsils taken out at another hospital and was referred to this children's hospital because he had developed an infection at the wound site in his throat.  It turned out that he hadn't been given any antibiotics prophylactically (before the surgery) to decrease the risk of infection.  But when he was sent home with antibiotics to combat the infection he'd developed, the infective 'slough' that was covering the wound came off and he started bleeding.  He arrested on the way to the children's hospital and although they revived him, he'd lost so much blood by the time they got there that he's now in a vegetative state (brain dead).  I guess that it's important to realise that even common surgeries carry significant risk and even though you might be keen to get out of the hospital after an operation as quickly as possible, if your Doctor wants you to stay longer, there is generally a very good and important reason why.

I'll end off with a few lighter stories that should be labelled under the WTF?! category.

I was observing an emergency repair of a perforated small bowel.  All of a sudden I could smell popcorn and I kept turning around trying to find who the hell was eating popcorn around the operating theatre.  Then I realised that the 'popcorn' smell was actually the odour given off by burning human tissue - the surgeon was using an instrument called a diathermy to cut through the abdominal layers and it 'burns' as it goes to cauterise (close off) bloods vessels to minimise bleeding.  I swear, I'll never walk into a cinema thinking the same thing about the smell of popcorn again.

'Scrubbing in' isn't as simple as washing to make sure your hands are clean.  It's this entire process of washing that needs to be learned, and once you've washed certain parts of your hands/arms you can only rinse in a certain direction and you can't come into contact with anything that isn't sterile (you end up turning taps on and off and squirting soap with your elbows/upper arms) and the process needs to last for a certain amoutn of time and then you repeat.  One of the guys in my team ended up having to restart scrubbing 6 times because he just kept forgetting and he'd accidently touch something that wasn't sterile - you felt sorry for him at the time but it's pretty funny when you think back on it.

I have come to realise that the male gender have a strange fascination with sticking things into their anus.  Unfortunately, many of them don't realise what a powerful muscle the anal canal is and that, in its case, what goes in must come out, isn't as easy as it sounds.  We had one young man who used a deodorant can, but when he pulled the deodorant can out, the lid came off and got stuck, so it had to be 'retrieved' at the hospital. 

I didn't see this case but one of the senior Doctors was telling us about another young man who came into the ER, visibly distressed and sporting an erection.  Taking his history, it was discovered he'd been playing with a vibrator and it had gotten stuck.  When he tried to get it out, it just kept getting pushed further and further inside.  Unfortunately for him there is a phenomenon called 'reverse peristalsis' whereby things get to a certain point in the large intestine and get 'sucked' backwards (small intestine direction).  Furthermore the poor guy had left the vibrator on.  So when the doctor listened to his abdomen to check for bowel sounds, he could hear this 'buzzzzzzzz'ing noise.  The Doctor telling us this story said it was the most awkward phone conversation he's ever had with his consultant surgeon as to why they needed an operating theatre - they ended up having to surgically remove the vibrator from his small intestine.  The lesson?  Hold on tight or have some sort of handle if your gonna play with toys.

Ahh so surgery wasn't too bad.  I think the whole experience was ruined by my illness.  But I have talked to my team's consultant surgeon and he's said I can come back at the end of the year and hang out in the OR with him, which I'm really looking forward to (surgery is amazing to be a part of).  But yeah, I don't think I would have gotten through this rotation without my friends pulling me out of the hole I'd ended up in, so thanks guys/girls! I owe you my life

One week of holidays, exams and then I start my psychiatry rotation!  Should be fun!

My way home is through you xx