July 21, 2017

Scrubbed up…

It’s now Specialist placement 5, the last block of year 3, and for me it’s my care of the surgical patient block. Despite all those years watching Grey’s Anatomy I’m not particularly interested in surgery and have spent most of my time in theatres so far thinking about lunch or how much my feet hurt! At the start of the surgical block I was definitely less than enthused and thinking more about my upcoming holiday in august than the anatomy of the abdominal wall, but I must say I have been pleasantly surprised!

I’m based at George Elliot, which is a small district hospital. Over the 6 weeks we rotate round 3 different surgical specialities: Urology, Colorectal and Breast Surgery. I’ve been with urology for my first 2 weeks, learning about different types of disease that can affect the prostate, bladder or kidneys that may require surgical intervention rather than medical intervention from the nephrologists. Clinics in urology are really varied; there is some overlap with gynaecology in women suffering from incontinence due to pelvic floor damage and there are lots of patients referred through the fast track system for worrying symptoms such as blood in the urine. Learning about the different investigations for these patients was something we covered last year but this year there is more focus on learning about the surgical management options, and how you decide which is best. Being able to get scrubbed up in surgeries means you can get much closer to the action and see the anatomical structures, and really appreciate the complexity of some of the operations. One operation to remove a patients kidney that had a tumour, lasted 6 hours, watching the surgeons avoid major blood vessels and control bleeding as they dissected the large tumour was fascinating. In contrast, another operation I observed was to remove a bladder tumour, which took less than half an hour-but to the patient these are both major, life saving operations.

As well as spending time in clinic and in theatres with the surgeons and anaesthetists we have also spent time with the junior members of the team while they are on call. The surgical senior house officer (not an FY1 but not a registrar yet) carries a bleep and sees all new patients that come into A&E or are referred by GP’s who may need to see a surgeon. This was a great opportunity for my clinical partner and I to take the history, examine the patient, come up with our differential diagnosis and decide what investigations we would want. The SHO was brilliant and gave us really useful feedback and helped us understand things we might have missed and importantly asked us to justify our investigations, something we have to do in our exams!

So 2 weeks in and I fairly sure I still won’t ever be a surgeon but so far I’ve learnt lots, which is always good with the prospect of 4th year approaching, and as an added bonus I haven’t fainted in theatres (yet)-win win!

Joanne


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