F1

NB:

Revision + Monaco Grand Prix = Unproductive Weekend

Suturing workshop

Instructed to wear lab coats or not participate the entire year descended on the lab for one of the more interesting components of dermatology - the suturing workshop. Not plastic prosthesis, cadavers or patients. The reason we were told, that we must wear lab coats was to prevent getting raw chicken on our clothes. Sometimes I wonder if health and safety take things a little too far, this being no exception.

To begin with, a quick demonstration courtesy of one of the best teachers I’ve seen so far. A few attempts at a simple interrupted suture and I think I got the hang of it, although I was lucky enough to get to place some in real patients during my ENT placement. With a little time to spare, we were taught how to do a more advanced vertical mattress suture. I can’t really remember what it is for, something to do with little old ladies with fragile skin. After further butchery of the chicken wing we got to play with a punch biopsy and some liquid nitrogen spray.

Vertical Mattress Suture

Due to time constraints we only had 30 minutes to do the workshop (although I decided to do it again with the next group, as a few students didn’t turn up). Earlier this week we were told it was one of the potential OSCE stations for our end of year exams. This later transpired to be inaccurate, as another one of the instructors told us the school is too cheap to purchase another hundred chicken wings to test us with.

I guess the next time we’ll get to do anything like this could be on real patients next year. Would be helpful if they could teach us how to administer local anaesthetic too…

Update: I'm still alive and flu-free

Final term and the second year draws to a close, well, not exactly as there’s still four weeks of teaching left, and study leave, and exams. Somehow ‘Unprotected Text’ has managed to maintain and even slightly extend its readership despite the rather callous neglect I have shown it recently. With nothing noteworthy to report and an air of disinterest in medicine these past few weeks for which I place full culpability on the tediously mawkish sociology unit, I’ve been unable to muster any musing.

Meanwhile as the country remains torn between barefaced brazen fury over MPs expenses whipped up by a media storm, and perilous unmitigated panic over swine flu, we remain anxious and unsettled by the impending end of year exams, whipped up by the medical school.

To add to the fray, we have been given fairly scant details and time for applying for our third year clinical placements. I understand it will be a logistical nightmare co-ordinating and meeting the wishes of hundreds of students, but can’t help to feel that come September I will be disappointed with my placing. Yes, I’m a cynical bastard even at the best of times.

In an effort to claw back some cash I’ve decided to move home for summer. Informed my flatmates the other night, which went down with some shock and disappointment. Maybe I left it a tad late in the year, but my paranoia suggests a slight air of resentment. As the only student, expressing a lack of cash-flow seems reasonable, but with their lifestyles (and they really do piss away their salaries) they now need to find a new flatmate as they cannot afford to move into somewhere smaller.

Unfortunately, anything and everything I’ve enquired about or applied to do over the summer has fallen through. Not just with a lack of funding, it would seem that even free labour is also too much to ask. For some consolation, it would seem this is true for quite a few of my friends too. After working the entirety of last summer in a forsaken hell-hole until intellectually numb, the thought of going home for a couple of months isn’t all that bad.

In the meantime I am preparing for lockdown, to enter the strange yet familiar domain of caffeinated highs, mitral stenosis, Osler’s nodes, placenta praevia, lobar pneumonia, neuroleptics, peak expiratory flow meters, Cushing’s syndrome and the rest of the crew. Goodbye, social life!

This little piggy stayed at home?

Checking my university e-mails this morning and this flys in:

Subject: Swine Flu Outbreak
To: All students

Dear Student,

The situation regarding swine flu is constantly changing and it is imperative that you take care to look at all e mails from the School over the coming days and weeks for updates...

(Boring occupational health info)

...If the situation changes for the worse it may become necessary to suspend teaching sessions such as lectures/PBLs etc. It is possible that some NHS Trusts may decide not to continue providing a teaching programme should a deterioration in the current situation occur. The School will try to keep students informed of developments.

And this little piggy sparked a global pandemic.

Dissection: The end of a sphincter

Week two of dissection, and after effectively hollowing out the thorax we turned our attention towards the abdomen. Here, there was some fairly interesting and unusual pathology to see throughout the room – a massive liver cancer, adrenal cancers, enlarged hearts and pacemakers. Unfortunately our body had been savaged by a sarcoma, skewing the anatomy making it difficult to identify a lot of structures.

Of course the most grisly and sickening moment of the course was saved right until last – a rectum packed full of old, partly-petrified faeces. It just isn’t possible to remove it all cleanly – that requires a lot of time, syringing and paper rolls, and it stinks.

Now I’ll admit that at the time (and this is far easier to see in retrospect), I shamefully started to blame the person that had donated their body. As if the cancer was somehow their fault, and that they could have emptied their bowels on their death bed for our convenience.

Like I said - shamefully, and I do feel genuinely so. But when you’re digging around a body cavity somewhat frantically, trying to find all the relevant anatomy and fully aware that there won’t be many other opportunities to do this again, it is possible to slip into such deplorable mindsets.

Instead, I found myself reciting one of the many mantras of medicine:

“Shit happens, deal with it.”

Dissection: Part Deux

There is something so exhilarating about standing over a body wielding a circular saw and cutting through the side of a partially dissected chest, feeling the individual ribs crack under tension. It almost feels like a small power-trip; only one immeasurably desensitised by previous demonstrations and practicals, and heavily regulated by the Human Tissue Act. What it essentially boils down to, is yet another rite of passage – a freak show in this circus of medical education.



To begin with we were given a few words of warning, reminded of the rules of respect and engagement, informed about the assessment and sent off to meet our cadavers. Fortunately ours was of fairly slim build, making the process and technical requirement a lot less demanding. No trepidation this time round, getting straight on with the task. After a while it felt completely natural. In fact, it became therapeutic. Making cut after cut, peeling away layers of muscle, skin and fascia. That may sound somewhat contrived, yet it was a most satisfying and mentally purging experience - and before we knew it, it was lunch.

The anatomy itself was far easier to identify this time round. Pectoralis major, pectoralis minor, serratus anterior and then ribs. A far cry from the bizarre mishmash of upper and lower limb muscles of the first year.

In our posse there was for some unknown reason four to the cadaver, with eight to a cadaver around the rest of the lab. Equally bemusing was that I’d somehow been put on the register twice, supposedly on two separate tables. Needless to say, with four to a body it meant pure unsolicited cutting the entire day. A rather undesirable consequence of thoracic dissection is the copious amounts of fluids that collect in the body cavity, which later slowly soaked into the arms of my lab coat.

But the highlight of the day had to be cutting around and removing the rib cage. Clean out, pleura a little torn and lungs lying dormant asking to be provocatively poked – the ultimate in stress relief is the peculiar bounce and return to form of the lungs recoil. Yes, it’s going to be an interesting week.

At your cervix

With legs forced wide apart, screaming ferociously as is humanly possible as a catheter funnelling between your legs runs straw-yellow. You shit yourself, with the paracetamol suppository making an untimely cameo – hello old friend. Finally your most intimate and sensitive area rips under pressure, all to the tune of “Grade-I tear, we’ll stitch that up in a moment”. This taking place in front of a crowd of midwives, doctors, husbands and of course, students. Yes, that’s the miracle of birth alright.

I was woken at some ungodly hour after about thirty minutes of sleep, my scrubs covered in meconium (bilious-green newborn baby shit to the layman) and blood from the earlier emergency c-section. “Come quick! Her cervix is 10cms dilated and she’s about to push!” I’ll be the first to admit, there are a lot nicer things to wake up to. Bleary-eyed I made it to the delivery room to see another mother go through what looks literally like a living hell. I think todays modern society has sanitised just how disgusting, painful and undignified child birth really is.

In fact, I’d go as far to say that none of the deliveries I witnessed had anyone particularly elated for the best part of twenty minutes after birth. The fathers looking fairly pale were exhausted from several hours of relentless screaming and hand-crushing culminating in what could be literally described as a bloodbath, as their loved ones are torn in two. The mothers being told “come on now, just one or two more pushes and it’ll be all over”, which sounds about as comforting as being told to expect just one or two more hits to the crotch with a sledgehammer and it’ll all be over. Anyway, in reality that isn’t entirely true as it’s then followed by a second, fairly disgusting ‘miracle’ of afterbirth as a sizeable placenta is gently teased out.

I did get the opportunity to scrub in at 1am for an emergency c-section. I’ll almost shamefully admit that I got a kick out of the added drama of rushing to theatre. The actual process of getting the baby out was over in minutes, and as the uterus was cut open a torrent of blood, amniotic fluid and meconium covered me whilst I stood there retracting and suctioning up blood. At which point there were a few screams from the cyanotic bundle of joy and everyone gasped a sigh of relief. The surgeons stitched her up as I continued to suction whilst trying not to get in the way, and I held a kidney dish catching rhythmic spurts of blood from the vagina as the surgeon pressed down on the belly after closing.

Another time during that night I was taking observations for the midwife when I got asked about the CTG (a clever machine that monitors foetal heart rate and contractions simultaneously). Yet I found myself in an uncompromised situation where I could reassure the mother and tell her that the reading was completely normal (which it was) or worry her by running off after the midwife, because we as students are not supposed to give out medical advice. So I settled for both options, saying I was almost certain there was nothing wrong and getting the midwife to double-check. I’m not sure if it was because I was the only guy on the ward that evening, assuming that everyone has this 19th century Dickensian attitude, but a lot of people assumed I was the doctor that night (which I corrected, over and over).

O&G is probably the most disgusting specialty I’ve seen so far, and also the most fun. So much so that it’s one I’d seriously give consideration for as a potential career.