New rotation and a new start this week. Finally leaving dermatology and its sparse timetables behind (though I am not going to lie, I am going to miss all those gaps) and moving onto ophthalmology; medicine of the eyes. Looking at the timetable on Monday, I could see that it was going to be a lot more hands on than dermatology, with clinics and tutorials in the mornings and afternoons of all days! Its going to be like my third year again, I hope I am not too old for all that work...
My favourite part of this week was getting involved in some eye surgery. When I say 'getting involved' I really mean watching some... It is very intricate surgery, and I think that letting a medical student try and assist would be a terrible idea. I saw several cataract removals, and a few retinas be reattached. Cataracts are where the lens becomes fogged in the eye, so you cannot see very well - the surgery involves removing the lens and replacing it with a plastic one, which is clear. Seeing as cataracts are one of the most common surgeries done by the NHS, and the most common cause of reversible blindness in the UK, this is quite an important operation. It is done by making a cut in the eye in the white of the eye, and working through this cut to 'suck out' the old lens after mincing it up, and then a new one is injected in through the same hole. This way there is minimal cuts made in the eye, and only the front of the eye is affected. It takes 15-30 minutes, which I thought was pretty impressive for surgery which involves sticking things in the eye. I was afraid it would deflate, a bit like a tire with a puncture when the holes were made. I am very glad it didn't!
The other operation is where the retina, the layer of cells on the back of the eye, starts peeling off the back of the eye (detaching) due to small holes in it letting fluid get behind it. This operation is similar to the cataract one, in that it is done down a microscope-like-machine with tiny instruments, but as the back of the eye needs to be operated on (rather than the lens which in the front). This meant a number of tiny tubes were put into the eye around the iris (coloured bit) and instruments were put down the tubes to seal the retina back onto the eye (keyhole surgery). Again, I did secretly expect the eye to deflate a bit, but I wasn't going to mention this to the ophthalmologist and get laughed at!
One of the patients who was having the operation had a female name, and long hair and jewellery but the notes said male and they did look distinctly male with a touch of shadow under their chin. This lead to a fun talk from the anaesthetist first, while the local anaesthetic was being put in the eye to numb the pain before the operation started. The anaesthetist kept talking herself into corners while chatting to the patient and us, saying things such as "when this young .... .... patient goes into theatre" and so on, with slightly awkward pauses as she was unsure whether to say man or woman... I was always taught you should refer to them by their chosen gender, but when unsure, best to avoid the topic all together! Fortunately I don't think the patient noticed the pauses (its likely they were more worried about the fact someone was going to stick knives and tubes into their eye in the next 30 minutes). As this patient only had a local anaesthetic to the front of their eye, I was curious as to what they had seen during the operation. The patient said that it was like a kaleidoscope of colours throughout the operation, and as they couldn't feel anything, not an unpleasant sensation at all!
Going in for an eye operation? You will get a trippy display to keep you occupied while they do what needs doing!
One of the other patients coming in for surgery had specifically requested to have a general anaesthesia for the eye surgery, as he hated the idea of people touching his eyes, let alone operating on them. After a long discussion the anaesthetist had agreed to it, and after putting him to sleep, the anaesthetist was teaching me and the other medical student there how to manually breath for someone with a bag-valve-mask (in the name, its a bag stuck to a mask with a valve between). It looks very simple - stick the mask over their nose and mouth and squeeze the bag, but it is a lot more complex to actually get the bag to seal over the face while keeping their airway open. The head needs to be tilted backwards, while keeping the seal with one hand, leaving the other hand available to breath. While I was making my poor attempt at this manoeuvre (and failing) the anaesthetist tried to help instruct me and move my hands to the right location. It was hard a manoeuvre in itself, but the fact that while I wasn't doing it, the patient wasn't breathing was pretty frightening... While I am well aware that the anaesthetist could have stepped in any time before it got dangerous, the fact the patient had been lying there for a minute, while the machine bleeped urgently at me really didn't help me try to concentrate on tipping the patient's head back just right.... I did manage to get it in the end, so no deaths to my name yet, fortunately, though after that shocking performance perhaps emergency medicine is not for me!
Despite all this talk about surgery, it was only a small part of my week. I also did clinics where I found out how little I know about eyes and eye disease, and spent some time in a huge warehouse trying to hunt down stored patient notes to help me in a research project that I need to do. This time was not well spent, as I found none of the notes I was looking for at all, but the sheer magnitude of the number of the notes was huge. Just thinking that each of these files was a person, and all of the sheets of paper in them were filled with their suffering was... indescribable. I am not sure I have seen a place which really sums up what a huge amount of work the hospital does in such an effective way before, but it was almost like some kind of cathedral or church to all the suffering from all of these people; waiting to be pulled from the shelves for the next attendance to the hospital...