Surgery

Hi,

I'm back after a nice holiday, and back on the working train. As the first week of a rotation, it wasn't typical, and we started off the week with 'introduction' lectures. These involved learning the history about the area we practice medicine in, the history of surgery, and the history of medicine within the area we practice medicine in. If this wasn't going to be too much fun for our poor bored minds after the holidays, we also managed to get a lecture from an NHS manager on the management of the NHS, the structure of the NHS system, and what managers do. Unfortunately this only served to reinforce the feeling that if anything in the NHS needs to get cut back, this would be a good place to start.

Anyway, moving on from the tedium of the first few days, which did serve to remind me how much more I enjoy the clinical years compared to the first 2 years of lectures, we spent some time with surgeons doing everything they do apart from going into theatre. A bit of a shame we haven't had the opportunity to slip into theatre yet in the first week, but next week... Anyway - I can see why surgery might appeal to people, you seem to do everything an physician does, as well as operate. You see patients with symptoms to plan investigations to diagnose. You prescribe drugs, you run clinics (though they seem to be the bane of the surgeon) AND you operate in your spare time. Despite all of this 'work' surgery seems a lot more relaxed than the other departments I have done rotations in so far. We were taken to the common room a couple of times, and had tea and coffee, watched the election on the TV, and had the opportunity to play some pool or table football. It seems that medics seem to have a lot more work to do compared to surgeons, who can wait around much more waiting for surgery to start, and so on.

Another wonderful thing about surgery is the fun nature that a lot of surgeons seem to have. The typical opinion across hospitals of surgeons is pretty similar to 'Scrubs', arrogant, less intelligent and jocks. That's the usual response I tend to hear, if I tell people I am starting surgery, or going to have it as my next rotation. For some of the surgeons, this isn't an inaccurate description. There are some particularly scary surgeons who have reputations across the hospital as those not to cross or annoy, and unfortunately I have one of these in about a month. Despite all this negative press that surgeons tend to get, many of them are really fun to be around. Not always taking things too seriously, they are often jokey and interesting to be around. It seems that many surgeons place a lot of value on general knowledge, perhaps hence the history lessons at the start of the rotation, and like you to know a lot of non-medical things (verging into more academic areas such as physics). The sceptic in me says that this could be because they don't need to know as much medicine, instead concentrating on manual skill for operations, but that would just be harsh, right!

Learnt a few important facts this week, though. Certain surgeons lock the doors as they start the lectures, in order to stop people from coming in late. Sounds a good idea really, but will probably mean about half the rotation don't benefit from the lecture. Also learnt that surgeons expect you to learn a LOT of anatomy. I was embarrassed this week because I couldn't name all of the vascular branches from the start of the Aorta to when it passes under the inguinal ligament in the thigh after bifurcating. This includes all the branches in the pelvis, and is quite a lot (supplying all of your body but the legs) -  but have been told I should know them all by Monday. The plan is if I do know them, I can assist in the emergency surgery list on Monday, which would be exciting. I have some work to do!

On that note, I managed to embarrass myself further last week by missing a patients femoral pulse completely.  The lady had arterial insufficiency to her legs, meaning they were ulcerating, getting infected and starting to decay because the cells were dying as they were not getting enough oxygen/nutrients. Peripheral vascular problems are very common it turns out. Myself and another medical student were asked to feel for this lady's femoral pulse, to see if anything could be felt to work out where the blood supply was being occluded.  A little awkward, as this lady was in a hospital gown, so we had to lift it up to around her belly-button in a cubical with about 8 people in, including us. I couldn't feel anything, and neither could my medical-student college. We reported this to the surgeon who duly wrote it down in the notes. About 5 minutes later, as part of the examination of the abdomen, a senior doctor pointed out that there was most definitely a femoral pulse, and guided out hands to it. It was very obvious, and I have no idea how I had missed it. Perhaps on the frail skin of the old lady I had gotten my land marks confused? Perhaps I was just being dense. We were 'firmly advised' to practice feeling our own femoral pulses 'in bed at night' - with a wink, so we didn't miss it again. Not only did I manage to stop here, but I managed to answer the question as to which bone the femoral pulse was felt against as "the Fibia" I was duly ignored by the doctor, but yes, there is no such bone as "the fibia" and yes, the correct answer would be femur, pretty much the best known bone in the human body. I should have known that around GCSE level, let alone now I am a 3rd year medical student. Not good! Needless to say, this was a pretty embarrassing day, but sometimes days just go like that, the brain doesn't seem to engage.

Well, I will wander off now to learn the branches of the aorta and to do an essay, and won't waste my time or yours rambling on any more. Hopefully next week I will have done some exciting things to report back. While exams loom and work presses on, I still want to get the most out of surgery and get stuck in. We did a workshop on Friday where I learnt to suture pretty effectively, so hopefully I can put that into practice!