Sunday, October 22, 2006

Other interesting tidbits...

Ah well back at home now, only to leave again in a couple of hours. This time not to Sydney though, but to Cowra doing a one week locum for my ex-employers. I really enjoyed my week doing the OT round in Westmead Hospital. The whole anaesthesia department there worked quite well as a team and they seem to have quite a few socials such as a trathlon and a fancy dress ball coming up. Its good to see they can also have fun together. Every morning, they get some loaves of bread in the tea room and there is always an endless supply of those little packs of jam, peanutbutter, honey and butter or margerine. I know that the dental departments don't get treated as well !! They even have cordial as an alternative to tea and coffee :P

During the last few days, I saw some other interesting things such as a caesarean delivery ... you could tell when the gynae cut through the uterus because water suddenly went everywhere! The patient had told us before she went under that this was baby no 4 so she had also requested for the surgeon to tie her tubes after the caesarean. Thus the baby was all cleaned up and put in his little crib and checked out by the paediatrician and mum was still asleep. The crib had a cool incubator heater thing over the top like a little shelter, but they didn't have to turn it on as he was quite healthy and pink. I had never seen a live delivery before ... really interesting to see something so new in this world.

I also saw the last bit of a leg amputation, a toe amputation (mostly diabetic patients), and I even had a day in the emergency OT where a guy on a motorbike had had a match with a truck and lost. He had a broken tibia (front bone in the calf) and a nail wedged between the two bones in there. When he met the surgeon he said "Your job is like mine ... you are like fitters and turners I've seen your instruments!" The surgeon just smiled ... I haven't seen what fitters and turners do but there was quite a racket trying to push the bone back in place without doing open surgery. Nowadays, just cutting a small opening and putting different tools in to move the bones or vessels is the norm rather than opening up the length of leg similar to the length of broken bone and setting it and sewing it all up again.

Another guy they brought in was eating an ice cream and driving on a freeway when he rammed up into the back of another car and had gotten caught under the dashboard. Not sure what happenned to the ice cream but he was a concern for doctors because he was very much overweight. This is a particular concern as drug dosages may need to be higher than advised just to get him asleep and that is a problem for his liver and kidneys. Also, they are concerned as the respirator machine also has to crank more gas in there to blow up his chest as his lungs are under quite a bit of weight. It was one case where I did not even want to try intubating and let the professionals do it instead.

Also heard .. patient to anaesthetist," Can you do me a favour? When I am under, can you watch where they put the leg tourniquet before they operate? Last time they caught my scrotum by accident. I couldn't move for 3 days and my balls went blue black!!"

I look forward to my next round of OTs which will be in March '07 and so will the sedation clinics. Meanwhile, back to normal drilling and filling. Will be looking forward to going back to Cowra and meeing up with friends again. Not sure what my net access will be like while there so I think the earliest I will be blogging again will be in a weeks time.

Tuesday, October 17, 2006

OR rounds...

Blogging live from the hospital library so no pics. Am doing a OR round or rather known as OT for operating theatres here in Aust. I'm attached to an Anaesthetist everyday and will be learning about maintaining an airway, even if the patient is unconcious. As well as the different levels of sedation and also getting a bit of cannulation in.

Yesterday was a good day. It really reminded me of hospital shows like my favourite at the moment, Greys Anatomy. I don't really know why I like it since there are so many things wrong I can pick with the occupational health and safety side of things. They would never, ever let anyone into the operating theatre with loose hair or even without a surgical cap on. Yet the main character moseys around the set with hair half in her eyes and flipping it here and there just because it makes her look pretty. Also, maybe someone from the US can also tell me why they let people walk around outside the street as well as in the dining room in their scrubs !! The main idea of scrubs is that they have no germs or coffee spills etc from outside that could contaminate the theatre. We have a zone that you have to get changed out of outside clothes into the blue scrubs plus big socks over your shoes and a sexy hair cap that makes you look like the canteen lady. Surgeons get to wear the ones that look more like the ones on TV ... but thats coz they are surgeons.... you gotta have some incentives.

Anyway, I got to peruse the whiteboard type thing just like on TV and see which room I was assigned to and away I went. Morning was a few small surgeries to free vessels so dialysis patients can have a better blood flow to some areas. Afternoon, I got the Anaesthetics Professor who beelives the only way to learn is to be totally free of aids such as the tubes so I had to hold the gas mask over the patient's mouth and nose manually for 6 operations for which a urologists stuck a very long steel tube up people's hoo hoos to check any cysts in their bladders. I am so glad I was not on the other end of the table. Its gotta be bad when there are stirrups.

Anyway, the registrar (or intern for you yanks) took pity on me and was giving me helpful hints like "The surgeon is going to stick the long steel tube up now so you want to make sure you have a very good complete seal around the mask so the patient doesn't wake up when he stick it in." Gee thanks. I never knew holding a mask down and holding a persons jaw up to have a clear airway could be so tiring. Some people's heads are really heavy!!! I got a good nod of approval at the end of the day though as the machine had good readings of oxygen saturations, and the patients were all comfortable at the end of the day. *phew*

Today it was the type of sedation I was more likely to do, which is using drugs IV to just send them sleepy but not unconscious. It was in a totally different department to what I am used to though .... colonoscopies. Still, I am impressed that the drugs were enough to make them not mind a metre tube being shoved up where the sun don't shine. I have never seem the inside of someones mouth and gut all the way to the other side before. Its enough to make me glad I am working on the end I am working on. I asked a gastroenterologist ..."whats that yellow stuff stuck to the walls?" "oh thats just poo" ooookay.... sorry I asked. It was neat how the camera could swing around and a little clippy thing could take some small samples from strange looking lumps in the walls. They were mostly looking for sources of bleeding though.

Well, back to the OTs now ... will write if have more interesting things to report on. Sorry no piccies. I am sure most of you out there will be glad not to see them though.