Thursday, 20 September 2012

Super Happy Sleepy Bean

Well, I have survived my first two and half weeks.  I think I have survived anyway.  I am still here, in one piece, but I think my brain may be making a pilgrimage back to bed.  I started last week on a chest pain week.  Myself and my partner turned up at the required ward at the required time, slightly terrified and wide eyed but keen to learn.  We were met by a registrar surgeon who took us through some basic anatomy and causes of chest pain on a white board in a theatre and within half an hour I found myself peering over anaesthetists drapes into an open chest cavity watching a heart beating.  A real live, actual beating heart.  It's a good thing I was wearing a mask because my mouth was wide open in amazement for the next 5 hours of surgery.  We don't do dissection here, so this was my first encounter with the real thing, and no text book can prepare you for what it is like to see a patient splayed out on the table in front of you: vulnerable and beautiful and impressive.  The surgery was a double coronary artery bypass graft and aortic valve replacement.  At one point, the surgeon looked at us and said "Now, for the first time in 77 years, this patient's heart is going to stop beating."  It was all I could do to stand still and not jump around the room singing "this is so freaking amazing!!!!".  Also, I really, really wanted to poke the heart.  Is that bad?  I wasn't scrubbed up so I couldn't, but the compulsion was there. 

The rest of the week was spent on MAU and in ED and the heart wards chatting to and clerking patients and then Friday morning saw us back in theatre watching a CABG and aortic root replacement.  This poor patient's ascending aorta was about 7cm wide, a healthy one is normally 2.5-3.  They opened the chest and it was there, pulsating angrily.  It was decided it was too big to clamp, as every time the reg touched it to prepare the area for the consultant pin prick bleeding started.  Part of me wanted to duck behind the drapes, certain the thing was going to dissect and spray blood everywhere.  The decision was made to put the patient in full circulatory arrest.  This means they were cooled to 20 degrees C, put on bypass and their blood volume drained into the bypass machine.  This would then give the surgeon 15 minutes to cut out the aorta and attach a synthetic one.  Impressive is an understatement.  This surgery was mind blowing.  At one point, I was looking down into the heart from the top where the aorta should have been but had been dissected away.  It was unreal; a view point you should never be able to see in a living person. 

This week is Palpitations and has been rather less exciting, but then probably anything was going to be after that.  My partner and I have spent a lot of time waiting around for patients or placements, and one of our placements was cancelled completely in favour of a departmental meeting.  I am waiting right now in fact, for my next placement at 1.  Happily, I passed my feedback session last week and my competency and professionalism judgement.  I practised my competency on my housemates who are engineers and they were such big wusses, they were terrified, even though the worst it was going to be was a needle prick on the face.  I guess, since I know the examinations inside and out, it's easy to forget the patient doesn't and they might be imagining you will do awful things to them. 

Mr came down now he has a couple of weeks off.  After the amazing surgery Friday we bombed up the motorway to his mess for a Ladies Dinner Night.  It was so lovely to see everyone again at what will probably be my last mess function there as he's moving bases now.  It was a little surreal though, to go from scrubs and blood in the morning and then fine dining and fancy dresses in the evening.  My feet didn't really thank me either, after a 7 hour surgery (and that was just my morning!) and then mingling until 3.30am in heels.  The next day we had a leisurely breakfast and then it was down to a family wedding in Exeter.  It was Mr's turn to meet Dad's side of the family, most of which I haven't seen myself since I was tiny.  It was such a good weekend, filled with everything I love but I am really, really lacking in sleep at the moment.  The hospital is a 30-40 minute bus ride away, so I am getting up everyday at 6 to be there for 8, and my housemates all have their fresher's week at the moment so they are being really noisy both when I'm trying to get to sleep and then again when they all traipse home at different times.  I am dead on my feet.  Hopefully, this weekend I'll be able to catch up on sleep a little more.  I am having a blast though, third year is amazing.  People keep mistaking me for being a real doctor, it's unreal.  If there could just be a few more hours at night to sleep, then I would be a super happy bean.  Otherwise, you'll just have to make do with a super happy, sleepy bean. 

Monday, 10 September 2012

New term, new town, new start

I finished the summer job, had a couple of days in Cornwall with mr, packed up my stuff and moved to my new home.  I've been here a week now.  I haven't really done anything exciting, it's mostly just been induction lectures.  All I can really tell so far, is that 3rd year seems packed.  It seems exciting too, but I'm pretty nervous.  My first term is based around acute care so I'm on the wards a lot.  I have one week in each speciality focussing on a specific presentation and then I move on.  Mondays and Wednesday mornings are for lectures and clinical skills and the rest of the time I will be on the wards and in theatres on placement.  Friday afternoons I will have a feedback session with a Consultant where I have to present back a significant patient I encountered during the week to be questioned on.  This is probably the bit I'm fearing most.  The Locality Sub-Dean asked at our induction lecture if this was the bit that everyone was most afraid of, and if we'd heard the Consultants were brutal and would grill us.  All bar one in a room of 77 raised they're hands in agreement.  He said that wouldn't be the case, but how did all of us hear it.  I shall just have to go into Friday as prepared and as confident as I can be, and see what happens.  

I am starting with a chest pain week and I have placements in the ED, MAU and cardiac theatre.  I'm not enjoying the early starts much, I'm finding it hard to get sleepy enough to go to bed earlier, but tomorrow is my first proper day on placements on all day, so I'm sure adrenalin will help to get me up.  During the course of the week I have to clerk and examine a minimum of 3 patients to log in my clinical log book, find a patient and get assessed on a cranial nerve, higher function, eye and ear competency and find two patients to take to the feedback session on Friday.  It will be fine, I can totally do this.  Yeah, so send good thoughts my way please.  I can do this, but a little luck can't hurt.