My operation

Hi,


This week I got a taste of the patient experience by having my own tonsils taken out. Not to be content with this, fate decided that my rotation (now ENT) would have me observing other people having their tonsils taken out the day before my operation, just to get me in the mood... Since my operation, I haven't really been in a fit state to get back on the wards and have been lazing around home watching day time TV and generally getting bored. I don't know how people do it, there is so little to do at home, but I still feel too out of it to start the essays I need to do...


Before my operation, I spent some time in outpatients seeing patients with problems with their ears, nose or throat (as the ENT moniker would suggest). I can now use an otoscope to look in people's ears to see the eardrum properly, but I don't really know what I am looking for once I can see the ear drum. Perhaps that will come with time... I also spent an afternoon with an audiologist, where patient's ears are tested to see what pitch of sounds, and at what volume, can be heard, plotting diagrams like the one below for each ear. From this you can see things like hearing loss and possible nerve or brain damage. 

An audiogram showing hearing loss into the higher frequencies, the most common type of hearing loss in old age.

One of the audiograms was very unusual, and showed a big dip in the middle frequencies, meaning they needed to be a lot louder for the patient to hear, which then rose back to normal for the higher frequencies. This was mirrored in both air conduction (noise from headphone) and bone conduction (noise vibrated into skull via an alice band) suggesting the origin was not a problem with the outer ear, but instead a problem with the inner ear and nerves. The cause for this could be something like an acoustic neuroma, affecting certain parts of the nerve going away from the ear and thus the hearing signals carried by those nerves. Obviously we didn't tell the patient these suspicions, and instead sent him to the ENT doctor who could carry out investigations such as an MRI scan to see what the cause may be.


The day before my tonsillectomy, I was in the children's hospital watching ENT surgery, which was some tonsillectomies, a few people who needed grommets put into their ears (to stop the build up of fluid behind the ear drum) and one boy who needed the frenulum under his tongue cut, as it was too short, meaning he was 'tongue tied'. Obviously, given the operation I was having the next day, the tonsillectomies took most of my attention. The mouth is held open by a metal gag, and fabric swabs put into the back of the throat to stop blood getting down there. The mucosa that covers the tonsils is cut through with a diathermy, then the tonsils are scooped out, a stitch was put through the area where the tonsil was to stop bleeding, and the area cauterised for the same reason. It didn't look too much fun, but not too brutal either... The surgeon I was with this day was the same one who was down to be operating on me tomorrow, but had given tomorrows list to a different consultant, as he had to be at a meeting. A shame, as I had hoped I could check on his skill!


The day of the operation, I got up early so I could have some breakfast before my scheduled 'fast' time, then went to the hospital. I was in the afternoon list, and was feeling pretty peckish by the time I was meant to go into theatre... All part of the patient experience I suppose! Either way, the surgeon and anaesthetist came to see me before the operation, and both were aware I was a medical student, it must have said so on my notes. This made the explanations pretty simple for the operation. The operation was all fine (I was asleep, I just remember the anaesthetic making me feel very light headed and 'trippy' before I fell asleep) but I was in quite a lot of pain when I woke up. I got some fentanyl, went back to the ward, got some oramorph, and had to wait for 4 hours before I could go home to make sure I wasn't bleeding. My flat-mate was kind enough to drive to the hospital to pick me up to take me home, as I was told I wasn't allowed to use public transport because of the risk of infection. The nurse on the ward was really nice and kind; I think having a nice nurse is much more important than having a nice doctor. You barely see the doctor in your time in hospital, whereas you see the nurse all the time! 


Now I am just sitting around at home, taking my codine, paracetamol, diclofenac and difflam rinse as often as possible, feeling pretty spaced out. Easter holiday next week, so I won't be missing any time on the wards, just time that I should be spending doing my essay. I apologise for the poor quality of this post, but I do feel a little out of it. Perhaps I will have to go back to some daytime TV in a bit, though after what i heard last week, I will be avoiding Jonathan Ross!