Thursday, March 9, 2017

Anaesthesia MO


Today I was scolded, or rather cynically told off by an anaesthetist.
She came in while I was looking at my phone during the surgery.
Perhaps she wasn't pleased with it - but to be fair I wasn't looking at my phone the whole time.
She came during that time I was looking at my phone, answering texts.
My luck.

It was an expected long operation - at least 5 hours.
Hence the anaesthesia practitioner MUST be present and continually monitor the patient.
I WAS monitoring the patient.
But I am still very junior in this field, there are still many things I don't know although I admit I should have studied more these past few weeks.

She then started quizzing me.
How do we calculate the fluids requirement for this patient?
Do I know the difference btw fluid maintenance, fluid deficits and fluid loss?
How do we calculate?
Fortunately, very fortunately I still have my HO-time note book in my pocket.
And I could produce a very good well calculated fluid regimens for her.
She complimented me for it, thank God.
But she wasn't happy that I did not calculate it before she comes in.
Hmm, some of my seniors will always skip this part hence I dont routinely calculate them - perhaps now I have to start practicing the good practice, and not just the routinely done ones.

The next question was on perioperative monitoring.
What do we monitor in long operations?
I could answer but I could not really tell the indications behind it - eg temperature monitoring.
Why is it so pertinent for us to monitor temperature in long standing op?
I know we have to avoid hypothermia, but why?
I know hypothermia reduces metabolic rate and sort of slow down our body, but I can't provide a proper answer for that question.

Well later on I found out that there is this thing called the Lethal Triad: coagulaopathy / hypothermia / metabolic acidosis.
Hypothermia leads to coagulopathy and met.acidosis which will in turn aggravate the met.acidosis and coagulopathy.

She then said something about Anaesth is a difficult field, people always think we sit idly during operations, but actually it is very difficult. She said I should read more, and not just sit down looking at my phone - right to my face.
And she walked off.

I felt so bad.
I felt so guilty
I felt like a disappointment.
My mood was so low the whole day. I did not dare to look her in the eye after that.
She was so nice to every other MOs - perhaps I have not gained her trust.
And from what happened today, it will be harder for me to prove myself.
I do not hate her. I brought this upon myself.

To make things worse, I woke up late this morning and was rushing to work.
Hence I accidentally wore sandals to work - instead of a proper pair of shoes.
And I have to go out to wards and do pre operative assessment for patients having their op tomorrow.
That made me feel even less professional - going around the hospital with sandals.
And I left my stethoscope in the car - which really, added salt onto the wound.

So now, I am sitting down and reading about anaesthesia concern on the types of operations I'll be doing tomorrow - the ENT list.
I hope I'll do better tomorrow.
And will regain the confidence I lost this morning.

-Because life is a test-


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