Orthopaedic Surgery: My First Experience

When the work experience coordinator said that I would be "in theatres" at a number of points during my week's work experience at the R.N.O.H, I was very excited indeed, but also nervous, as I had never watched surgery take place before.

Theatre implies a show, and what a show there was. The first drama was the very sight of the patient. When I walked in, all scrubbed up, the patient was asleep with general anesthetic and covered up with sterile blue sheets. He was entirely covered from view except for his left leg, which was being coated in yellow plastic, (I later learned from a nurse that this was to minimise skin shedding of the patient, that may get into the wound). Then came the first incision. It felt like my legs had gone from underneath me. The sheer shock of a person being cut up in front of me, albeit anesthetised, is a momentous one. Furthermore, as you look at the patient, in this case a small boy, you can't help but plead in your head that they'll leave him intact.

However, after the initial shock of the mechanics of the procedure, I soon calmed down. Even now, my first observations seem incredibly naive, in hindsight that is, but I've included them here for perspective. I was comforted by the conversations I had with the lovely anesthetists during the rest of the surgery. Having someone there to explain what is happening is immensely reassuring, and takes the nightmarish qualities out of the experience.

Likewise, seeing the measured cooperation and calmness of the team around me filled me with an equivalent composure, and I began to appreciate the complex surgery that was being undertaken in front of my eyes. Indeed the rest of the week followed and I saw a dozen surgeries, I am hugely grateful for the experience and became so accustomed to the blood and gore of that week that I am slightly concerned for my mental wellbeing as I doubt it is normal for a human being to be unperturbed by an entirely open leg, arm or hip of their fellow man. 

Regardless, I enjoyed the fascinating experience, and my first exposure to surgery.

Image source: http://ossmig.orthop.washington.edu/Portals/1/OR1.jpg

Feelings of a cancer patient.

 I cannot begin to imagine what kind of emotional and physical strain that the brave people I met last week go through on a daily basis when battling with their respective cancers. However, after talking for a while with a couple of patients, nurses and the doctors that know them about their experiences, I have begun to grasp some of the common hardships that are felt between patients with vastly different cancer types. Understandably some of them feel vulnerable, some feel lonely, some feel helpless. Some of them feel positive, others do not. The transition between an active, independent lifestyle to a nearly bed-bound state for many of the in patients can be upsetting. Even something as simple as washing yourself becomes a debacle when you need a stranger to scrub you down, which, although the nurses are exceptionally caring and understanding in their approach, it is understandable that some patients found it demeaning. It is something so simple that I had previously taken for granted, a registrar pointed out to me as we were doing a ward round that most people haven't been washed by someone else since they were a baby, and to return to such a state after a lifetime is often demoralising.

The registrar also voiced the fact that when you're in hospital, a doctor will walk in on a patient using the commode and apologise, only to have the patient, according to the registrar, say "It's alright, come on in." In everyday life for most of us this would not happen. Of course, the doctor-patient professional relationship is in place for a reason, as the doctors and nurses alike need to be able to asses the wellbeing of the patient and provide treatment, and this is often only possible by doctor and patient shelving their everyday attitudes regarding personal care, and proceeding with the best patient care possible.

Furthermore, I received a first hand account of how a patient can feel objectified. An in patient, who we'll call Mr Cox* told us how he felt as if he has become a list of symptoms to his doctor. Not all the time, he was keen to stress, but sometimes, and it was understandably very draining. The "endless" questioning he was subjected to about his final wishes, and his condition, Mr Cox told us, made him very depressed. Even though the doctors were asking ultimately for his benefit, he did not like repeating himself up to five times a day, particularly as he could rarely report  back any good news.

Despite this, during our conversation Mr Cox was quietly optimistic and good-humoured, even though he had decided to give up on the chemotherapy and live his life at home from now on, and he was looking forward to seeing his dogs every morning.

The moving conversation that we had with Mr Cox showed me how ignorant I was of what strains the patients are subjected to, completely aside from the vicious effects of the chemotherapy. It broke my heart to hear it, but I believe that Mr Cox is one of the bravest individuals I have ever met, I felt humbled and privileged to speak with such an inspiring man.

*All names on this blog have been changed to respect patient confidentiality.

I wish him all the best for the future, thank you for reading.

Be a dentist.

In a break from ward rounds, a group of the SHOs, the other two students from my school and I found ourselves talking about dentistry, and how it compares to medicine. Out of the five SHOs in the room, when asked, only three would choose to do medicine if they had their life again. At first glance, this seems like good odds as it is the majority, but I find this a tad disconcerting. From my point of view, all of these individuals are, in essence, living the dream. They got into medical school and came out the other side, they're well adjusted to and seemingly happy with a job that I aspire to work my way towards, and yet only just over half would do it again? Should I be concerned about this fact?

When my friend asked whether he should do medicine or dentistry, the response of "do dentistry" overwhelmed that of medicine, with four of the SHOs discouraging him from their own profession! Of course, the scientific side of me is having a field day, as this is by no means a reliable study, simply a random sample of the professionals that were in the room at that time, and is by nobody's standards a conclusive survey. Nevertheless, the conversation was an interesting one.

Their reasons were as follows, and though the final verdict of "I would rather not have been a doctor" was not shared by all, everyone agreed on the reasons that the dispassionate (disillusioned?) two put forward. Firstly, that there was no such thing as a nine-to-five job in medicine; one was nearly always working.  In the first couple of years, you are a "dog's body" as one SHO put it.

Another disadvantage of being a doctor is you get moved around every four to six months, although refreshing, this can lead to leaving behind a whole set of friends and maybe even living spaces, if you're moving somewhere far away, a couple of times a year!

Now, of course, medicine is a vocation and I can definitely see that, but something else that came up in the open conversation in that relaxed afternoon in the office is the number of friends' gatherings, parties, weddings and even sleep that every SHO had missed out on. One, let's call her Lucy, couldn't even confirm whether or not she could go to her best friend's wedding, as she had not been told whether she was "on-call" that evening. They stressed that although it isn't often required per se, you have to stay on some evenings simply because any doctor worth their salt can't just leave one of their patients when they are needed, for whatever reason. From my own limited experience, I can completely understand this, each day of work experience at the Marsden was scheduled for us to leave at five, but every evening we stayed on for a couple of hours longer - and we didn't have any responsibility for the patients, let alone any skills that we could utilise, we stayed only out of sheer interest in their well being.

They SHOs all agreed, however, that under no circumstances would you be bored at work as a doctor. On a fundamental level, you are using your skills and dedication in a team of people that are striving to improve as many lives as possible, and relieve human suffering, and I don't think you can ever escape that intrinsically admirable fact, and it is definitely one of the most compelling reasons I have for wanting to be a doctor.

So where to go from here? I would like to talk to some more doctors about how they find the balance in their job, and learn more so that I can evaluate whether this profession is right for me.

Personally I am not interested in dentistry, and I mean no disrespect to dentists when I relay this to you. But the response that they gave my friend who is considering it was summarised in the following choice phrase "if you want to be bored and rich, be a dentist." Make of that what you will...

Finally, I am very grateful to the honesty of those lovely SHOs if they're reading, it's not easy to admit if you regret something, but I am incredibly thankful that they were so blunt about what they really thought about being doctors. This way, if I do decide to enter into this "fresh hell", I can at least go in ready, with my eyes wide open.

What would you do?

Patients have, quite rightly, a lot of choice in their treatment and their view is generally held above everyone else's. However, I've noticed in my brief time at the hospital that, quite understandably, the patients just want the safest-sounding option for their treatment. Although the facts and figures help in their decision making, ultimately to some patients they are just numbers, and they rely on their doctor for some straight talking advice. All they want to know is, if it were you doctor, what would you do?

The MDT Meeting

In my time at the Marsden I sat in three MDT meetings, and they were referred to at least four or five times a day aside from this. From this you can see how integral these meetings are to the daily workings of the hospital.

The "MDT" stands for "Multi-Disciplinary Team" meeting, and essentially it is where everyone that is associated with a patient's care comes together to discuss treatment, review objectives and eat a few biscuits.

Each patient under a consultant is talked about in depth, their latest blood count, their CT (computed tomography - learn more here) scans, their progress through treatment and their general well being is covered.  It was here that I really got a feel for how integral teamwork is to successful patient care. The amalgamation of professor, nurses, registrars, research nurses and other key team members was impressive to say the least, because for each patient a different opinion is heard, and in this way all the information is present at the same time, leading to a streamlined system of care.

However, later in the week one of the registrars and I were seeing a patient (I say seeing, what I mean is that the registrar was seeing the patient, I was mostly nodding and accidentally getting under people's feet). This out patient, I'm calling her Mrs Williams*,  had been discussed in that morning's meeting; she had pancreatic cancer, and had just finished her third cycle. In the MDT meeting it was concluded that she was responding so well, from a medical point of view, that her treatment would be extended for another one and a bit cycles. This all sounded very promising, but later that day I was there when we saw Mrs Williams in clinic (learn more here), and she told us about the side effects she was experiencing. Which I learned vary between chemo treatments, as each plan is tailored for the patient, sometimes different drugs are used, or some are left out all together - hence the diverse side effects. Mrs Williams was alarmed by the size that her ankles had swelled to as a result of the chemo, and she was in pain. The registrar, too, was concerned that there may be clotting in the left leg that was much bigger than the right, but both looked painfully enlarged (similar to in this photo), with the skin stretched uncomfortably. Furthermore, she was suffering from constipation, excess urine and nausea, all very uncomfortable conditions. An ultrasound was proposed by the registrar to make sure there were no clots in the left leg which could lead to more problems. This lady and her husband were frightened of the seemingly alarming side effects, to the point where it was only reluctantly that they agreed to carry on with more cycles of the chemo. The registrar prescribed a cocktail of drugs to deal with the side effects; which for Mrs Williams means another set of pills to take every morning.

Afterwards, the registrar was telling me that there is a major flaw in the MDT meeting set up, because discussing something in a meeting in a boardroom with colleagues and biscuits is very different to seeing the patient right in front of you with hugely swollen ankles who can barely walk. There isn't much that can be done about the problem, but it's there.

Thank you for reading, I wish the brave Mrs Williams a comfortable and speedy recovery.


*All names in my blog have been changed to respect patient confidentiality.

Taking Patient Histories

We were shown how the registrars (who are they? learn more here), the Prof and other doctors deal with patients that have just been admitted to the hospital, usually by their GP. Most of the people we saw had at this point been already diagnosed with cancer. Although this is a sombre setting, for the oncologists it is part of their daily routine, and meeting patients for the first time in clinic is often refreshing, because every person, and unfortunately every cancer, is unique.
Seeing the registrar collect a patient history was mesmerizing to listen to. Though I'm sure it requires great practice, she made it look as effortless and breezy as a coffee morning chat. As we said our goodbyes to the patient, the doctor showed me her notes: they were detailed, clear and concise, yet she never even broke eye contact with the patient for more than a few seconds! Witchcraft!
I've noticed that communication is vital skill in Medicine, and although this would seem obvious I never really understood it until shadowing the four different doctors that I did today. Each had a different approach to understanding their patients' concerns, but all of them were reassuring, clear and genial in their address of the patient. Of course, the patients deserve nothing less, but I can more clearly understand why medical interviews for universities place so much emphasis on interview. It's a people person job, and listening is key.


Thanks for reading!
 

Work Experience First Impressions

Today I undertook my first day of work experience shadowing and observing registrars, nurses and consultants at the Royal Marsden (Sutton) and I was scribbling down notes all day, twenty pages worth in fact! I planned to do a blog post about all my experiences that I've had today, but rather than write what would be a rather mammoth post, I've instead decided to break it down into digestible, hopefully even interesting, accounts of my glimpse into the fascinating and varied world of modern medicine.

For now though, just three of my first impressions of one of the most state of the art, welcoming and genuinely friendly hospital environments that I've ever found myself in: there is a tangibly strong sense of community at the Marsden, the staff are exceptionally talented and hardworking at what they do, and the patients definitely appreciate the excellent care that the hospital provides.

More to come, thank you for reading!