王盈方醫師瘋狂之旅 Dr Yvonne Wang's Blabberings

Breast Endocrine Surgery (2/20/06-3/31/06)

Week 1

Monday: Meeting the team
Met the Registrar, Fellow and Resident. The team had heaps of patients since they were just on-call recently. They were all very friendly and keen to teach. Based on the Registrar’s surname and outward appearance, I suspected that he was the son of a Consultant at St.George.
There’s an interesting patient on our team by the name of GH, who was born with hydrocephalus and intellectual disability on our team. He had gastroscopy a week ago, which was normal. The next day he vomited and was found to have small bowel obstruction. Anyway, he was operated on and was still in ileus.

Wednesday: Cyst explosion
First day in theater! Scrubbed in for excision of a breast cyst (recurrent cyst). This cyst suddenly exploded on me! Greenish brown liquid splashed on my mask and neck… and it dribbled all the way down…….. YUCK! Had to shower before going off to Prof Morris’ tut at 11! And just when we thought he couldn’t make it, he turns up, and started his reign of terror! Basically he picks a student to come up to the front of the class (which is essentially all the 6th years at St.George), and asks the student a management viva question!

Saturday: Mentor training
Went for a day of mentor training at POW. Very few 4th years turned up from St.George for the “mentor-mentee meeting” though.

Week 2

Monday: Monstrous list on Monday!
GH started getting quite sick today. There was a monstrous preadmissions clinic list!! 25 patients!! And not enough doctors! When I went to the clinic, only the Fellow was there seeing patients. He saw around 4 or 5 patients then the Resident came… and then he had to go to the ward to see GH, who was getting critically ill by then. So it was only me and the Resident seeing the patients. I only saw 3 patients. Must’ve been very tiring for the Resident!

Friday: The med students’ invasion!
It’s only the end of 2nd week and we thought everyone would be pretty relaxed. We heard about some good patients and decided to see them…. And guess what? Many rejections! Students have already started attacking patients in swarms!! The 4th years already knew and seen “good” patients before us!

Week 3

Monday: Traumatized by the cannula
After preadmissions, I went up to the ward and did a cannula. This was quite a traumatizing experience! The guy had an old cannula in place w/ drip running and I didn't know how to take the drip off etc. So I did it on the other arm. It took ages before I found a suitable vein, then ages before I got the flushback (coz I was advancing the needle sooo slowly). Of course I was happy coz I've hardly been able to do a successful cannula back in 4th year. However, since I hardly gotten beyond the flushback stage before, I was very crappy at the steps after: I push the tourniquet release button, and thinking I released the tourniquet, I untwist the needle away and then blood SPLURTED! The patient got upset. Had to wipe all that blood off. Then I started sticking on the Tegaderm, and I stuck it the wrong way!! So I had to take it off and grab another one. I didn't bother flushing the cannula since I was sure it went in.... and I called the resident and she said better flush it coz the blood spurted out and so it could clot, but I didn't dare to go back to the patient, so I didn't flush it. By the way, I didn't do any cannulas at all during my electives or 5th year.... so didn't have a chance to improve this skill since 4th year

Tuesday: Registrar’s tut
Our Registrar started giving 4th years a tutorial! He invited me to attend as well. It was great! He teaches so well!

Thursday: Son of the Consultant
Theater staff talking: the Registrar really is the son of a Consultant at the hospital, but he doesn’t really want people to know.

Friday: Day off
First time I took a complete day off in 6th year. Really needed to start reading up. Besides, the operations were starting to get rather boring/repetitive.

Week 4

Wednesday: Killing patients
Prof Morris told us that we will definitely kill patients accidentally in our medical career, no matter how careful we are! Man, such a sad reminder. He said he’s seen doctors in training who actually suicide over these mistakes! But it’s bound to happen to everyone!

Thursday: Ouch, an inguinal hernia!
The Registrar had the Trauma pager the previous night… and to my surprise, one of our fellow 6th year med student at St.George (AW) is under our team! AW had an incarcerated direct hernia! He thought it was getting quite big and had umbilical discomfort for a few days. So he was afraid his bowels might have gotten in there! Then he told me that the Fellow told him that they had to dissect his ilioinguinal nerve because it was in the way! So I asked the Fellow about it and the Fellow said AW got it totally wrong! They routinely cut the ilioinguinal nerve in hernia patients to prevent postoperative neuralgia!
Another great highlight was that the Resident took me to see a patient with Bell’s Palsy! She watched me do the history and examination and gave me feedback! That was very useful.

Week 5

Monday: True Thyrotoxicosis
In preadmissions, I saw this anxious thin thyrotoxic lady. She was anxious about everything. Very stereotypical of thyrotoxicosis!

Wednesday: Air hunger in the elevator!
It was 15 minutes into the Prof Morris tutorial, and hardly anyone turned up – not even Prof Morris himself. So one of my classmates, a silly guy called Davis, called his mate. As it turns out, a group of students got stuck in the elevator! Davis said “I will go and rescue them!” A little while later, Davis came back with a dozen of students. Man, did he really rescue them all? As it turned out, too many students got into the elevator (like a dozen), and the elevator malfunctioned and wouldn’t open! One of the students was planning to just force the elevator door open, but decided not to because there was a sign (a cross over a hand) saying “do not force open”. As they waited, they got pretty sweaty and started competing with each other for air! So they had to wait for the security to open the door. So in conclusion, Davis did not rescue them! And Prof Morris did not get stuck in the elevator – in fact he didn’t turn up!

Week 6

Monday: Patients not turing turn up
For some very strange reason, very few of the patients turned up for the preadmissions clinic, and many arrived late.

Wednesday: Chaos - Surgical Registrar on call
My Registrar is on call on Wednesdays. The Fellow told me during the first week that I should follow my Registrar whenever he has his overnight shits! However the Fellow always looked like he was half joking when he talks, so I decided that maybe I should only go once or twice. I finally decided to follow him. The Registrar’s pager kept going off today!
In the afternoon the Registrar gave us a tutorial in the ED. We did it on a lady in her 80s w/ incacerated paraumbilical hernia. She had 10 children one of her births resulted in triplets. Anyway she's got big hernia, and like 7 medical students all peering at her. Even the fellow came in to take a look. The room was just overcrowded w/ ppl. Then I followed the Registrar and Fellow to theaters after the tut to watch the lady’s operation. She's got huge hernia! There were many hernia sacs within the hernia, and there was a small bit of jejunum.
During the operation the Reg got called. They say this old man had dehiscence of laparotomy wound! Like all these bowels came out – the small intestine and left colon! He had a rocky course at hospital: Gastroscopy 3x, large volume hematemesis from Mallory Weiss Tear, partial gastrectomy (and had trouble seeing stuff coz he kept bleeding), L arm cellulites, sepsis and acute renal failure! He seemed to be getting well a week ago, and today, he suddenly had wound dehiscence! When we went up to see the man, boy was he scared! He kept mumbling; saying to give him analgesic, put him to sleep, and complained "no one's doing anything... different people come in and out in and out and no one's doing anything." Anyway we rushed him to the theater and used saline to wash his abdo cavity up several times and re-closed the wound
After that, we saw 2 kiddies who got hit by the car in the ED. One girl has Down's syndrome. Then we saw this old man in his 80s who had this HUGE AAA! It was a 6-7 cm AAA which pulsated like mad! He was hemodynamically stable though. While in the ED, I bumped into some of the 6th year students doing the ED term!
At 9pm, the Reg had to go back to theater to do this appendicectomy... so I parted ways w/ him and came home.
When I met up with the team the following day, the Registrar was dressed in his operating gown and looking very drained out! His pager kept going off throughout the night and had no time to sleep! There was a guy who came in with torsion of the testes at 5am, which would’ve been interesting to watch! Oh well, I shouldn’t lose my beauty sleep over it anyway!

Friday: Last day
Finally, the last day of my term. The thyrotoxic lady had her surgery this afternoon. She got so anxious she started crying and crying! The Registrar kindly did the evaluation form for me and gave me very useful feedback.