Wednesday, October 24, 2012

Dear Surgeon, Would You Like to be ON THAT Table?


I am 3 weeks into Obstetrics and Gynaecology posting and I am already dreading it.
I come home everyday with shivers down my spine, recalling how the surgery went and imagining how it will feel like being in the patient's shoes.
I don't hate Obs and Gynae, I am just not interested in it, at all.
In contrast with Paediatrics posting I have just finished with, the patients in Obs and Gynae are all very do I describe it, "not cute"?

Birth Suite
Thank God I kicked off my O&G posting with one week in the Birth Suite. And when I say suite, I meant SUITE. The Birth Suite is a Consultant-led unit where there are 12 en-suite rooms with bath tub in the toilet in each room and the privilege of getting an epidural anaesthesia to cope with childbirth pain in contrast with Birth Centre where the unit is wholly midwife-led and no epidural can be performed. Midwives are allowed to prescribe limited dosage of diamorphine though. So my first week in O&G was filled with cute babies popping out of their mothers, painfully. But I can't help to notice the "bloodiness" of O&G. I helped with the delivery of the placenta and my hands were literally full of blood. Even my white plastic apron were blood stained.

And I witnessed one emergency Caesarean section where the mother was wheeled off to the theatre within 40 minutes of her arrival and recognition of fetal distress (because we can't feel the baby's moving and heart rate was bad). And it was bloody as well.

Gynaecology Theatre
After the one Birth Suite week, I started going into theatres and wards and clinics. And my my my, I can't stand the Gynae theatre. Most of the procedures were either laparoscopy or hysterescopy. When any procedure ends with -copy, it means we are viewing the structure, and most of the time it is via a camera rather than the naked eye.
So the camera will either be put into the patient's abdomen or through the women's vagina, cervix and into the womb to visualise the inside of the womb.

Both camera procedure will need clamping of the cervix. Yes, clamping.
I do not know if there is any specific medical term for it but a clamp (imagine a clothes clip) will be put onto the cervix and the cervix will be pulled up so that the womb will be pulled down so that the surgeon will not puncture the womb when she cuts through the lower abdomen to insert her camera and instruments.

And the sorts of clamps and theatre instruments used in the procedure are just freakingly traumatic! Traumatic to the cervix and vagina, I'd say.
They were merciless and vicious. Maybe because the surgeons did it so many times that they are doing it in an autopilot mode.
The surgeon need to clean the vagina before she starts any procedure to ensure the area she's working on is fairly sterile to reduce the risk of infection. And guess what, she shoved the instrument that was wrapped with cotton pads into the vagina just like that, mercilessly. Patient is asleep, of course. Patients are all under general anaesthesia. They can't even breath on their own, what more feel the clamps and pliers and needles. I'm sure the patient would have kicked the surgeon flying across the room if she was awake and knew what the surgeon did.

I know my description sounded very grim and horrible and cruel and I do not know if all surgeons do that or it's just this one but I doubt other surgeons take their time to clean the vagina gently, or clamping the cervix gently (if it can ever be done) when there are many patient waiting outside to be wheeled into the theatre.

And I doubt male doctors are any gentler, the one my friend was with certainly wasn't. He sounded even more vicious!

Whenever I see the surgeons clamping and shoving things inside there (which is almost 5 times a day), the question that was burning inside me will always be "Doctor, would you want THAT to be done to you?"
I can almost bet with my life that none of them will willingly want that to be done on them.

And I hope, I truly truly hope that none of my friends, family members, wives of friends and myself will ever get any kind of Gynaecology diseases that will need us to undergo these procedures. These procedures are not done for nothing, they have to be done. But they are unbelievably terrifying. And even though I know that our body has a remarkable ability to repair itself, the cervix can even dilate and thin out and the vagina stretch enough to let a 3kg baby out, a clamp and camera for 30 minutes are almost nothing but still, it's just......cruel.

I hope I won't get into trouble by writing this. I am always afraid my writing will one day drive me into some kind of trouble, revealing unnecessary things and this time, it might make some potential patient scared to death of a procedure she's about to go through. I am sure the doctors do not explain or show the instruments going to be used when they asked for her consent. Because if the patient knew, she will never give her consent unless she's too desperate to get sorted out.

And yesterday, I saw a baby being crushed and vacuumed out of her/his mother's womb. I might talk more about that later. I need to rest, and keep my mind clear of the traumatic look of the cervix (I had the chance to examine the patient while the surgeon was suturing). Bloody!

-Because life is a test-

[Image Credit]


Paediatrics Posting


This post was actually written about two weeks ago but I didn't have the time to finish it up so here it comes!

I've finished my 7-week Paediatrics posting and are now on my second day of Obstetrics and Gynaecology posting.
In the past 7 weeks, I felt as if I was thrown into a deep, dark hole and the cliff I had to climb to see the sun was just unbelievably demanding. However, it did get better towards the end, perhaps because I acquired new clinical skills and had tremendously sharpened my survival instinct.

In Paediatrics, I became used to running to the bus stop to catch the shuttle bus to Burnley. Used to pacing up and down the ward corridors because there was no patient waiting to be seen. I became used to talk and chat with the senior house officers (SHOs) when I used to fear them last year.
Used to make a cup of coffee while studying the doctor's room because there was no patient.
But most of all, used to be in Paediatrics and I must say, I actually enjoyed and loved this placement!

And to be honest, being in Blackburn is not that bad after all.
The room is good, though small. And we do not have to pay the utility bills and I can switch the heater on 24 hours. BUT, I do not want to stay here permanently. 14 weeks is enough, thank you.

Being in Paediatrics, I've seen a lot of things. I think this is the first time I am truly acknowledged as a medical student. I am doing things junior doctors do, although I do it either under supervision or I'll have to tell a senior doctor what I did so that they can check if I did it correctly.

Assessment Unit

I enjoyed the time being in the Assessment Unit, where unwell children who came in referred by their GP or after being through A&E are assessed whether they need to be admitted or are okay to go home.
I will first see these children, take history and perform some examination before presenting the case to a Registrar (a very senior doctor) and tell him what I think is happening to the patient.
Best of all, I can write on the assessment sheet, devise my own management plan, print my name and sign it off (although no nurse will actually act on my management plan, because the Registrar will review the child later and write his OWN plan). But still, I feel like I am part of the team. And the nurses and doctors were so nice to us. The only person that's not so nice to us are the parents. Some parents are just so annoying and frustrating!

Neonatal Unit

I had one week in the Neonatal Intensive Care Unit (NICU) in Burnley.
Here, I saw very small tiny babies, some are barely 500g!
And they have wires and tubes and needles attached to them, it's sad. I can't imagine what the parents especially the mother will feel seeing their babies in that condition. It must have been heart-breaking. These babies are mostly preterm. Term babies who are for some reasons can't breathe properly, can't get their blood pressures or temperatures maintained or any other problem will be sent into NICU.
One very sad baby that I saw was a cocaine intoxicated baby. I can't remember how many weeks was he but his mother was on heroine while pregnant and really could not be bothered about him. And she was a known sex worker. She did not attend most of her antenatal appointments and refused to see the social worker. She had two previous babies who she fed methadone to "help" them with their withdrawal symptoms and these babies have been taken away from her. This time around, this baby will also be taken away from her and sent to a foster home. They even put a warning not to let her visit the baby unsupervised.

The baby was so irritable and had severe tremor, he was obviously in withdrawal.
His cot had to covered by an opaque cloth so that he is in dark and his blankets wrapped around him and tucked underneath his mattress so that he is sort of "tied up" in the blanket. These measures are to reduce disturbances to him, and his cry was very different from other babies' cries.

It was so heartbreaking to see that innocent little human who suffered the aftermath of his irresponsible mother's action.
Few potential foster parents came to visit him but there have been some changes in plan so as for now, no one has agreed to take him in their care yet. And he was Hepatitis C positive.

I pity him, to the bottom of my heart. But I can't imagine myself adopting a baby like that. Perhaps it is because I believe nature and nurture come hand in hand. Even if I raise him perfectly, he might have the "not good" genetics and turned out bad. I know that's very cruel of me to think that way but I can't help but believe it. That is why our beloved Prophet's bloodline was so protected and they can trace his ancestors for more than 5 generations (I cant rmember exact number).

Perhaps I should end my rants here.
This post might be too long already.
Thank for reading and take care!

-Because life is a test-