Day 11: Surgery and ED at Night
Well today we woke up to find it raining again, and not just a slight rain- I’m talking absolute downpour & wind- i.e. tassie weather! (who would’ve thought that I’d come to Qld and spend half the time in rainy weather). We took a gamble and decided to head to the hospital at 8am anyway, so our normal 10 minute walk turned into a 10 min dash and naturally we got SOAKED (and a lovely car decided to speed past me over a puddle- you can guess how I ended up :/). We decided not to turn up to handover looking like drowned rats, so I headed up to surgery for our planned surgery morning.
Today there were 2 theatres operating (+ the endoscopy theatre), so surgery was in full swing- with 1 private dr and anaesthetist in one theatre and one GH dr and anaesthetist in the other. Because there was quite a full list we got to see quite a few new surgeries- especially hernia removals, BCC removal, and a few scopes. This made it quite good for both me and the other med student as we had both just covered GI in our course (and I had learnt about BCC in first year). We learnt that hernias were repaired using a special square gauze to “plug up” the hole/weakness through which the hernial sac extended, and the surgeons quizzed us on what we knew about hernias, which was quite useful to bring it all back.
Watching the scopes was also pretty amazing. We watched 2 colonoscopies and a gastroscopy- learning about how they were inserted and then watching the scope go through the various parts of the bowel/upper GI (which all looked alike to me on the screen- its amazing how the surgeons know exactly where they are in the bowel!). None of the pts had any major defects in their GI tract, but we watched a few punch biopsies take place. I noticed that the patients were in quite a bit of pain during the procedures, which surprised me a little- I expected them to be a little uncomfortable, but I didn’t expect them to moan in pain throughout the procedure.
After a bit of an exhausting day in surgery, we took a break and headed back to ED at 7pm for our planned night shift. Tuesday night was a pretty quiet night- unfortunately ED is a bit of a “luck of the draw” place and so we spent a lot of time waiting around to see if anything would happen. We did hear of one urgent emergency case - but we didn’t get a chance to actually follow up on the pt.
One particularly interesting case for me and the other med student that did happen was an ordinary non urgent presentation in the consulting rooms. A pt presented with shortness of breath and non radiating chest pain and their bloods had returned raised LFTs. We watched the ED dr take a cardiac history (- ahh finally something we’d practiced endlessly in our course! If only he’d let us take the hx and do the examination- it could have been my moment to shine ;)) Anyway we watched as the dr ruled out cardiac problems and came to a diagnosis of infection as the most likely cause of their SOB and pain. However the problems didn’t end there and by the end of the consult the pt left with referral to the alcohol team, the diabetes educators, a counsellor, possible admission to the ward and told to get plenty of rest! This consult had so many classic elements that were covered in our course (cardiac history, GIT history and examination, LFTs, alcohol hx, MME, referrals and more) and it was good to finally see something like that.