Sunday 3 July 2011

Ready? Get set... Surgery

I am not one of life's surgeons. It's medicine all the way for me. Having said that, I came out of my surgical placement this year feeling smarter, more confident and able to present patients a lot more succintly. And I really enjoyed myself. If I can do it, anyone can. Here are some hard won lessons that I will definitely be bearing in mind next year.

On the wards
1) Surgical ward rounds are fast-paced, which makes it hard to sit down at each patient. Consider sitting out alternate patients, or bays in the doctors room. Alternatively, do your own WR over a day. See each patient and review their notes at your own pace. This is very good for learning, especially if you don't peek at the diagnosis before seeing them (except if the patient answers your opening "what was it that brought you to the hospital?" with "I had a massive heart attack"...)

In clinic
2) Surgical clnics are as speedy as the WRs, and doctors tend to walk from room to room as the nurses shuffle the patients so there's not much chance for sitting. Again try seeing alternate patients, or taking regular breaks (starting before you get tired, not after). In certain clinics, for example one-stop breast clinic, it's really useful to shadow one patient through the entire process. This is naturally paced by the queues for each procedure!

Don't always feel the need to stay for a whole clinic. Go to the ward, or the library to read up on what you've seen.

Looking the part
3) Wear clothes that are easy to get in and out of, and compression stockings if you are prone to fainting or getting all oedema-y in the feet when you stand. If you need particularly large, or particularly small scrubs, it's worth snaffling a pair from the hospital buying your own pair (you can get fairtrade ones here).

4) Buy your own clogs if you have musculoskeletal issues. I'm coming to my 6th month of achilles tendinitis and plantar fasciitis after wearing a pair that didn't fit out of the spares bin (even though I was sitting down almost the whole time!). In most places closed toe crocs are fine. You can (at least in my trust) also just wear shoe covers over your normal comfy shoes.

Pictured are a pair of wooden clogs, painted bright orange, against a
grey background that looks like concrete. These would not be practical
for theatre but at all! Picture by garyknight on flickr.

5) I didn't take my stick into theatre, but if I had, I would have made a cover from a pair of old-and-falling-apart scrubs bottoms, or something. I plan to ask a friendly scrub nurse for something suitable next time.
[Update : When I took my stick into theatre, I was just asked to clean it with hard surface wipes. Obviously, I couldn't use it while scrubbed in. When I started using the wheelchair, one hospital let me bring my chair through the changing rooms and just leave it to scrub in, but another made me leave it in the changing room. I talked to theatre sister in advance about when I was going to be where and she helped me sort out a stool to sit on.]

In theatre
6) Scrub in at least once, even if you can't assist. It's a good skill to learn, and it's all kinds of fun. Ask a scrub nurse to show you how to do it properly. If you do assist, don't for more than 10 minutes the first time (even if non-disabled and/or not holding on to a fat flap / retractor). It's harder work than it might look.
[Update : You can sit down while scrubbed in. During my gynaecology placement I assisted for full lists while sitting down.]

7) Ask a scrub nurse or technician for a spare stool if you can't find one (or ask the anaethetist to borrow theirs if they're not using it). Theatre stools don't usually have back support, so it might be worth talking to you supervisor / disability advisor to try and sort something out if that's a problem. [Update : one hospital I had placement in also had higher stools (think barstool height) which are normally used for optho surgery - these were great for being able to see the field while seated. It's always best to chat to the surgeon about where is best or you to sit so you won't be in the way]

If you can't stand at all, or for long periods, then laparoscopic or opthalmic procedures are great because you can sit and watch what's going on on the screen. Most urology surgeries and some breast surgery (axillary node clearance) are carried out seated so you can see the field sitting down. [Update : I was primary assistant on full gynae lists while seated, without any issues.]

8) Pace yourself. Seeing 3 of the same procedure back to back is not the best use of your time. Sit often, for short periods - don't wait until breaking point to have a rest, and between patients go and sit in a more supportive chair in the break room, and have a drink and snack.

9) Drink plenty of water, don't skip breakfast, and don't be embarassed to sit down or leave if you feel dizzy. It's much less embarassing that fainting into the surgical field (luckily I didn't learn that one by experience!)

10) If you don't have a specific anaesthetics placement, spend some time with anaesthetists during your surgical placements. They are very good at explaining physiology (but be warned, they also ask really tough questions about it...), and there are plenty of chances for procedures (venflons, airways etc). Plus there's lots of sitting. Next time I also plan to shadow a scrub nurse for a list.

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