Despite 3rd year being officially over, done, finished, finito…I still have 3 more blocks to tell you all about! And then after that I have some more fun blog posts planned, so keep reading. My 3rd block in year 3 was possibly the most exciting, Surgery!
Now I say the most exciting because I’ve never seen any form of Surgery before so it was a brand new experience! As well as being new and exciting, Surgery was also my most exhausting block by far: much earlier starts; looonnng theatre sessions where you’re just stood in one spot for hours trying to avoid being in the way of the operating staff; very teaching heavy. Each week in Surgery we had to fit in at least a clinic, a ward round and a theatre list (which means we had to squeeze in an extra clinical experience compared to our other blocks).
Now a bit more about the type of Surgery we could see. There were 4 surgical specialities we could explore in this block: Colorectal, Upper GI, Urology and Vascular. And…since we had 4 weeks on Surgery I tried to spread my time equally between the 4 areas. One of the things I noticed in this block is how the approach to taking histories, examining patients is quite different in Surgery compared to Medicine. Everything in Surgery is quite focussed around and in context of the operation the patient is due to have or has had. For example, if a patient has got a distended abdomen in Medicine you might be thinking of liver failure, IBS, organomegaly etc and building up your differentials thinking about all the systems. However, post-Surgery, the first thing that would come to your mind would be an anastomotic leak, intra-abdominal haemorrhage and other complications linked to the procedure. Sounds obvious now that I say it out loud, but it did feel like a shift in perspective thinking about things medically for 12 weeks and then going and looking at them through the surgical lens.
Surgery was incredible, but exhausting as I said earlier and having a look at one of my weeks on this block might help you understand why…
(Green is compulsory, red is clinical experiences I’ve signed up to.)
Spent the whole day in an Upper GI Theatre. The procedure was a cardioesophagectomy which is when part of the stomach and the oesophagus is removed due to oesophageal cancer. I was originally meant to be there only for the morning, but the procedure is done in 2 parts: the first half is laparoscopically and then the second half is open. So that’s why I came back in the afternoon and I’m so glad I did. The open part involved going through the ribs of the patient so I was able to see the lungs inside and the heart beating as well! That was an incredible opportunity. I stayed beyond my time in the afternoon till about 6 pm, but the procedure still hadn’t finished!
Had bedside teaching this morning. The teaching was structured in a way that we were all given individual patients to go and take a history from and examine and then we had to come and present our findings. It was a really great learning experience because we could then talk through the patient’s case, investigations that were ordered and logically make sense of everything that was done and why in our heads. The afternoon I decided to keep free so I could spend some time in the library going through the week’s case. Didn’t manage to be very productive though as this was only our second week on Surgery and I was so exhausted I was falling asleep all over my laptop!
It was really hard to fit in our clinical experiences for Surgery as our timetables were so full, so we were allowed some overlaps. First thing in the morning I had a Urology ward round. I had to leave the ward round slightly early to then go to my Clinical Debrief session. Clinical Debrief involves us talking through the week, sharing experiences and then 1 person presents a case. We have a cake rota going as well, so this week it was my turn! More bedside teaching in the afternoon, this was carried out on a Urology ward focussed around surgical complications. We went to see some patients on the ward and tried to piece together how the post-op symptoms they were experiencing could be explained by the procedure they had. Finally, to finish off my longest day on Surgery I had my On Call where I was supposed to follow the Urology registrar. There weren’t may Urology patients so this was a fairly relaxed 3 hrs. I tried to make myself useful by helping out with some bloods but there wasn’t much else to do. So turns out Wednesday was a whole day of Urology!
Bedside teaching in the morning. This was quite examinations focussed, we learnt how you’d examine a stoma and how to identify what type of stoma it might be. After that I dashed off to theatre to watch some robotic surgery which was pretty cool! It was a prostatectomy and unfortunately I couldn’t watch the whole procedure, but we did get some incredible Anatomy teaching from the on-screen view. I did some more work the week’s case, but this time outside the library to try and keep myself awake. To end the day we had a colorectal seminar talking us through the most common colorectal presentations.
I scrubbed up for the first time in a theatre session today – it’s amazing how much more you can see by being able to go that bot closer. It was a vascular theatre so I saw an open repair of an Abdominal Aortic Aneurysm! In the afternoon we had our TCD session which was fittingly on triple As! In the SCT session we were able to do some role plays practising our communication skills in difficult and emotional scenarios e.g. financial difficulties, domestic abuse.
And that’s a wrap. An exhausting but incredible week!