dissections

dissecting aortas, that is!

wasn't personally involved in caring for the patient - but my friend was. turns out the intial complaint was of upper back pain, not resolving despite iv morphine. On his very good suspicion - CT aortogram was done, which showed...

A STANFORD A DISSECTION.

WHAT THE BLOODY HECK! how rare are these compared to msk strains and the like!!!! omg. @_@

so vascular came down to see patient - arrangements made for him to be transferred to a level 1 cardiothoracic surgery centre were in place, and ambulance was right outside waiting, when...

THE PATIENT COLLAPSED.

again, WHAT THE BLOODY HECK! he went into VF and was shocked. at some point, the vascular attending was there along with the vascular and CTS senior residents (having driven madly down from the level 1 centre). omg.

decision for emergency thoracotomy was made, and internal cardiac massage done. it was so abso-bloody-lutely thrilling to watch the heart being massaged and shocked with internal paddles, a feeling i cannot quite describe except that my heart was in my throat, hammering away, and felt like it was about to jump out at any minute.
there was SO MUCH BLOOD evacuated from the pericardial cavity. that must have been some dissection (and it was, when i saw the CT scan!).

it was all very well and thrilling, until they decided to call off the resus. the patient's daughter is from the same college as me, and i felt so super sad when she turned up in her logo shift and college badge :( :( :(
i mean, things always hit closer to home when you can relate somehow, eh?

am totally grateful that i managed to witness all that (hiding behind curtains, perched on a stool, hidden by the human wall of nurses). it was really quite amazing, not to put too fine a point on it. well worth my staying back over an hour to see what happened!

emed simultaneously repulses and thrills me. i detest drunks/regulars, but i absolutely LOVE the thrills of a resus! seriously considering emed, but i'm not quite sure if i can actually give up ob/gyn or the OT!

things that make me happy: starbucks peppermint mocha in the largest kick arse size :) :) :) love the cheery festive packaging too! :D

Emed

1 month into emed and i quite like it! :D

really regretting my decision not to put emed as one of my residency choices - but it was a toss up between ortho and ob/gyn anyway!

being the closet adrenaline junkie that i am, i LURVEEEE resus shifts! :D low BP, unresponsive patients, collapses, RTAs/multi-traumas, STEMIs - WHOO HOOO bring them on! :D :D :D
(alright maybe not so closet)

learning many procedures, still can't tube very well. chest tubes are lots of fun, T&S is alright, loveeee M&Rs! (i think i sound crazed here, sorry!)

still not entirely used to shift work, suffering from bad gastritis. losec is my saviour, i must say! really must learn to eat properly on shift, no one is going to thank me for giving up meals/toilet break in the long run anyway.

thankful for nice senior doctors and friends around :D

breather

yessss it's the long weekend! :D

just what i needed - started it all with a great call on thursday night - unbelievably good! :D
well, except for 2 things:
1) my attending REFUSED to let me do an evacuation - i was most upset!!!! no reason for refusing, it was a straightforward simple case!
2) my delivery wasn't the best, perineal tears up to the urethra and clitoris, OMG. thankfully the episiotomy repair wasn't epic, took me only 30 min. still, i hope she has no problems peeing!!!
cute baby though :D <3

enjoying myself muchly this weekend, going to have a rest and sleep till i have functional decline, hurhurrr!

oncology

... gynae-oncology, to be precise.

the patients are such sickies, and i fear that most of them won't make it.
it saddens me immensely when we prep the patient for op, hope for the best, and when we open up - tadah! tumour everywhere.

it just feels like such a waste, the intensive pre-op tests, the hopes and expectations, and i don't know, the feeling of being beaten before you've begun?

but thankfully, my bosses have much more experience than i do, and prof (being the awesome prof that he is!), will "roll up his sleeves and plunge elbow deep into the muck".
if i'm EVER having any gynae op, i'm definitely getting prof to be my surgeon!!!! sheer awesomeness!!!!

EBL for a certain Wertheim's was 6L - more than the blood volume of the patient! yet patient is still alive and kicking (not very well, but you get the idea). chances for this patient look good :D i am so amazed.

i used to wonder, who would ever want to do onco? but now, looking at my rotation through (obviously you need a heart of gold, think it's possible for me to grow one?) gynae-onco, i think it's a very worthwhile and fulfilling career path - i just don't know if i like it enough to want to reach elbow deep into the muck everyday! :\

caesars

i was happily sitting in my clinic on friday, shaking my legs, dreaming of watching world cup later that night (hey, i'm entitled to! the patient load on friday is light as all trainee residents have to go for centralised teaching, leaving us non-trainee residents behind to do the proper work. bah), when i suddenly received a call from The Boss himself (head of dept!).

The Boss: (booming down the phone)"DITZY! come up to OT and assist me with the CS."
me: "oh ok yes sir sure sir anything you want sir" (grovelling in shock)
The Boss: "STAT!!!" (proceeds to hang up phone with a click)

so i hang up my phone, grab my bag, tell my clinic assistant, and sprint out of clinics and into the OT changing room (i change in under 3 minutes, what an achievement!) in under 5 minutes (and am totally breatheless by time i arrive in the OT).

spying The Boss already prepping the patient (and thinking "OH MY GOODNESS that should be MY job"), i open my mouth and squeak "sorry boss! will scrub now" breathlessly. so uncool. :\
however, The Boss threw me a ?grateful look - to which i was clueless as to why at that point in time.

opening the scrub door, who do i see but the "Hopeless Intern" (names have to be kept hush hush on this blog!) happily taking his time to scrub up. :\ now the reason for the grateful look becomes clear!
the circulating nurse hurries to open my gown and gloves and quickly bundles me into them, all scrubbed up. i even manage to put my hands on the patient before Hopeless Intern! geez.

surgery was adhesions +++ arghhh. unable to see bladder, unable to see uterus. everything was just stuck together in one big mess. i couldn't figure out where to put the doyen's, i had no clue where the ligaments were - really need to spend more time in OT!
Hopeless intern was really hopeless. despite The Boss' and my instructions, he just couldn't do anything right. i don't know if it was his first time in theatre and he was freaked out by all the blood and gore in sight, or if he was just sleeping on his feet cos he was tired, or if he was just hopeless.
but despite instructions like "my dear, the DIATHERMY please" or "ARTERY please" or "please DAB, not swipe", he just couldn't get it. The Boss was highly frustrated, and had me doing most of the assisting for the op. thankfully he's pretty nice and i've assisted in a few caesars before so yelling was kept to a minimum.

i ended the caesar with liquor in my crocs and blood dripping down my pants and splashed liberally across my crocs. ewwww. but mum and baby are doing fine so i've no complaints :) :) :)

CAESARS = LOVE :D :D :D

i love caesars!!!!! a happy outcome is always good, esp when you get something like NRFS. scary! thankfully baby cried a short while after, neonates proudly dangled him up at us whilst we all smiled in relief :D :D :D

i'm learning to take the ridiculousities that A&E sends in stride, no point getting angsty and emo over crap cases like "constipation colic. please review for ovarian mass" (hello, how are the 2 even related???).

another tough week at work awaits, 1 month of clinics, dear God, please help me :\