Two Down, Eight To Go

Yay! Another rotation is over! My exam this morning marked the end of the surgery rotation. All of a sudden I found myself with free time and no studying waiting to be done. With a week off until the next rotation starts, what am I going to do with myself?!


I live only twenty minutes away by foot from the beach, but I haven't gone there in a while. So after lunch, I decided to get on my bike and ride down to the beach. I wanted to do some reading, but most of the books on my sagging bookshelf are my med books - the last thing I want to open today and for the next week. So I stopped by the local library and checked out a non-med book.


Every time I go to the library browsing for a good book to read, I invariably end up in front of the travel section - whether it's travelogue or travel guide, I always end up checking out a few of them. Now, armchair travel normally just doesn't do it for me. But when traveling is not possible at the moment and is not even remotely on the radar, I'd have to live vicariously through other people. So I picked up Greater Nowheres: Wanderings Across the Outback, a book about a couple of journalists driving across the Australian Outback in pursuit of the deadly salty - the salt-water crocodile.

Then I sat on the beach and started to read the book until the sun set. Not a bad way to end the day.

Friendly Fire

It was just another day in the operating theater, anther lap chole. I scrubbed in with the surgeon. My role was, again, to hold retractors and cut sutures, etc., which I didn't mind. I've always enjoyed assisting surgeries, no matter how minor they were.

As I stood next to the surgeon holding a retractor, he released a flap of tissue with the pair of toothed forceps he was holding and bumped against my hand. "Sorry," he said and proceeded to the next task. As I handed the retractor back to the scrub nurse, I noticed a nick in my glove. "I think I have a nick in my glove," I told the scrub nurse. "You'd better change that," replied the scrub nurse. As I took off the glove, I saw a bit of blood right where the nick was. "You're bleeding," said another nurse. "That's a needlestick incident. You'll need to unscrub, fill out an incident report, and go to A&E to get your blood tested."

That was how the rest of my afternoon was taken up by writing an incident report, opening a patient file for myself at A&E, getting blood drawn, etc. I didn't even feel the forceps puncturing my skin and the blood on my hand may or may not have been mine. The chances of picking up diseases this way is extremely small. But to follow protocol and for safety's sake, I'll be having my blood tested for Hepatitis B and C, syphillis, and HIV, among other nasty blood-borne bugs. And again six months later.

Well, I'm not going to lose sleep over it because sometimes, shit happens. Plus, I need my sleep so I can study for the end-of-rotation exam this Friday.

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Tonight's culinary experiment: pita wrap with baba ghanouj, chicken, zucchini, roasted mushrooms, and yoghurt sauce. It wasn't too pretty, but was highly edible. I made baba ghanouj with extra garlic a few days ago and the garlic flavor has definitely intensified since. Hmmm, postprandial garlic breath...

Hand-Eye Coordination

I assisted in a laparoscopic cholecystectomy today, in other words, key-hole gall bladder removal. It was my first time driving the laparoscope camera, and it showed. My hands were far from steady, not because I was nervous, but because of my unfamiliarity with the instrument and, apparently, my bad hand-eye coordination.

You know how when you cut your own hair with a pair of clippers, you use two mirrors, one hand-held and one on the wall; when you try to move the clippers while looking at the back of your head through two mirrors, they often go the opposite you want them to go? No? Am I the only one still cutting my own hair? Okay, maybe I'm the only one. But if you do, you'd know what I'm talking about. Handling the laparoscope camera was a bit like that. Every move I made was amplified on the TV screen, so the surgery started to take on a bit of the "Blair Witch Project" quality after a while. Well, maybe that's a bit exaggerated, but I don't think the surgeon was too impressed with my camera work.

Afterwards, I had a brief exchange with a junior surgeon:

Junior Surgeon:
Do you play video games?

Me:
No, not really.

Junior Surgeon:
I could tell.

Me:
Does Minesweeper count?

Junior Surgeon:
You know what I do? I play Flight Sim.

So video games is the solution! Oh, I so wish I could go back in time to junior high and tell my mother, "No, mom, I'm not 'just wasting my day playing video games,' I'm training for my future career as a surgeon!" Yes! guilt-free video game sessions! Now, where can I find Flight Sim?

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Speaking of gall bladders, I saw a news article about a brand new approach to removing it. Don't want scars? How about let's go through a natural orifice? Hmmm, how about the vagina? A team in France performed a transvaginal "no scar" cholecystectomy, and another team in New York did another one. What'll they think of next? Removing the appendix through the mouth? Wait, that's a possibility too! Crazy surgeons.

The Joy of Blood and Guts

Oh, surgery! Every morning when I check the surgery list I'm like a kid in a candy store - eyeing it up and down and trying to decide which ones to see while checking what emergency cases have popped up. The ritual of changing out of the professional wards attire, the dress shirt and pants, and into theater getup, the always ill-fitting scrubs, is like metamorphosis of the caterpillar. The lowly medical student goes into the changing room and emerges as the ever-ready surgeon's assistant, sprinting to the scrub sink at the slightest sideway-glance from the surgeon. Hold up the patient's leg while he's being draped? No problem! Hold back retractors for hours on end until my fingers fall off? Sure! Suction? Slurrrrrp! Cut open that grossly-distended section of resected bowel and examine the consistency of its content? Gladly! Do I want to come in on Saturday to assist on an amputation? You don't have to ask twice!

So it's too bad the rotation is going to end in less than three weeks. It's a pretty hard act to follow, and I'm not sure if mental health rotation that follows is going to do it for me. Sigh...

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Dinner tonight: chicken and potato curry with raita

The Obesity Epidemic Up Close

Australians are fat! I know it's a gross generalization, but the sad statistic is that Australia has an obesity rate second only to the fattest country on earth - the good ol' US of A. I know there's a fat-acceptance movement out there to make obesity less of a social stigma. However, even if it becomes socially acceptable to be fat, it will still be a huge problem for these people medically. From these two months of seeing patients, I've come across more fat patients with obesity-related problems than I care to remember. Both yesterday and today, I've been in surgery with two morbidly obese patients whose problems wouldn't have been there if they were within normal weight.

Yesterday I assisted in a circumcision. No, it wasn't like the routine mutilation of healthy baby boys for non-religious reasons that's still widely practiced in the US. This was a man in his late thirties with diabetes, too heavy for the operating table whose capacity was 140 kg. He had so much suprapubic fat that his penis was completely surrounded and swallowed up by it. Because of that, he couldn't keep it clean and kept getting infections. Circumcision would be part of the solution, but as long as he has that much fat around his penis, there will be plenty of skin folds for bacteria to grow and cause more infections. My job was to push down on the fat around his penis so the surgeon could perform the circumcision. If he weren't so fat, this would have never become a problem in the first place. I don't know, but if I were him, there might be a point when I might think, "Gee, I think maybe I should lose some weight," like when my penis turned into a vagina, or maybe when I could no longer pee standing up?

Today I watched a hip replacement surgery on a woman. Again, another morbidly obese patient. The anesthetist couldn't find a vein in her hands or arms to put in a cannula; they ended up putting in a central line through the jugular vein in her neck. Her obesity put her at very high risk for general anesthesia; a spinal block would be much safer for her. But it took two anesthetists to dig through her lower back to put in the block. Surgery was delayed by over an hour because of all the difficult prep work. To have adequate access to her hip joint, the surgeon had to make an incision twice as long as a normal one. Even with her hip wide open, the surgeon had to dig in there like he was working with his hands down a well. The surgery was successful, but she was at a higher risk for postoperative complications and her new joint wouldn't perform as well for as long.

Those two were just the latest of a constant stream of overweight and obese patients I've seen over the last couple of months. I know they are extreme examples. I don't want to blame the victims, but only if obese people are totally helpless victims. Yes, there are things, like genetics, that are beyond control of the person when it comes to obesity, but they've got to take some personal responsibilities - there are so many things people can change and manage to control their weight. Of course it's not easy; if it was, there wouldn't be overweight people. It's not about going on a diet to lose 5 kilos to fit into that dress for a wedding, it's about changing the lifestyle to gradually get down to a normal body mass index and keep it that way; it's about not losing a leg, not going blind, not dying on the operating table unnecessarily!

All right, I'll get off my high horse now.

I'm All Thumbs

After drifting for a couple of months, I'm finally settling down - well, for eight months anyway. From now until the end of November, I'll be doing four rotations in Hervey Bay: surgery, mental health, GP, and internal medicine.

Surgery rotation, consisting of two weeks of orthopedics and six weeks of general surgery, started on Monday.

Having done a bit of orthopedic research in my former life, I am all over it. So when the first time I am asked to scrub in and assist in a hip replacement surgery, I run to the sink and scrub away: scrub scrub, under the nails, palms, back of hands, scrub scrub, fingers, between fingers, wrists, arms; ten layers of skin later, everything below my elbows are squeaky clean. Remembering the proper sterile technique I learned at the beginning of rural rotation nine weeks ago, I back myself into the operating theater, dry my hands on the sterile hand towel, put on the sterile gown - so far so good, I haven't accidentally contaminated anything yet by touching unsterile objects.

Then I proceed to put on the sterile gloves. Picking up the left glove with my right hand behind the right sleeve, I gingerly put it over my left fist, which is still inside the left sleeve. Tucking on the left sleeve with my right hand, my left hand slip through the sleeve and into the glove - but into the wrong fingers. As I try to get my hand out of the glove without contaminating it, a nurse says from across the room, "Dr. Young, you look like you're struggling a little bit," with just a dash of schadenfreude. Oh, she must enjoy tormenting new doctors and med students. I say sheepishly, "Yeah, my fingers are stuck." "Just take it off and start a new pair." I rip off the glove and put on another one, but as I pull on the glove, my right hand slips and touches the glove. She says to another nurse but sounds more like announcing it to everyone, "Can you get another pair of 7 1/2 please." She walks over, pulls the glove wide open, I put my hand in, she lets go, and my hand goes down and touches the edge of the drape. "Another pair!" she's thoroughly enjoying it now. After five pairs of sterile gloves, I am finally gowned and gloved. Way to go for that killer first impression! Feeling like a giant boob, I walk over to the operating table, being conscious not to bump into anyone or anything while keeping my hands in front and just below my chest.

Assisting in surgery sounds a lot cooler than what it actually involves: holding a retractor with one finger and another one with an elbow while suctioning the wound with the other hand and holding the patient's leg between your legs. The only perk is that you get to see the surgery up close, but you also have a pretty good chance of getting splattered while the power saw cuts its way through bones. But at the end of the day, after inhaling the acrid smoke from the diathermy burning through flesh, trying not to pass out from the fumes coming off bone cement being mixed, and wading through the puddles around the table, you know that underneath the acres of sterile drapes, someone will have a pain-free hip, it feels damn good. And I didn't even do the surgery.

I just hope the joint doesn't get infected. And I need a pair of comfortable clogs.